Emerg Med J. 2025 Nov 23:emermed-2025-214861. doi: 10.1136/emermed-2025-214861. Online ahead of print.
BACKGROUND: The establishment of an emergency medical services (EMS) pathway into a virtual emergency service-the Victorian Virtual Emergency Department (VVED)-introduced a video-enabled telehealth consultation service for patients assessed and treated by paramedics. This study examined the utilisation of the VVED by EMS in Victoria, Australia, including its impact on rates of non-transport to hospital and EMS reattendance.
METHODS: A retrospective study of all presentations (aged ≥12 years) to EMS between October 2021 and May 2023. EMS data were linked to VVED records. Surveys were distributed following VVED consultation to explore patient experience. Interrupted time-series analyses were used to evaluate the impact of VVED on non-transport rates and EMS reattendance within 24 hours. Multivariable logistic regression analyses were used to determine predictors of non-transport and EMS reattendance.
RESULTS: There were 914 747 EMS presentations within the study period, of which 30 433 (3.3%) were referred to VVED. Compared with those not referred, those referred to VVED were older with fewer vital sign derangements. Of VVED referrals, the median case time was 23 min shorter compared with cases not referred to VVED, and 74% were not transported. Compared with baseline, the VVED phase-in period was associated with a non-significant change in level (incident rate ratios (IRR): 1.03, 95% CI 0.99 to 1.06) and significant change in trend per 30 days (IRR: 1.01, 95% CI 1.01 to 1.02) for non-transports. Full implementation of VVED was associated with a step-reduction (IRR: 0.96, 95% CI 0.92 to 0.99) and downward trend per 30 days (IRR: 0.99, 95% CI 0.98 to 0.99). In both the VVED phase-in and full implementation periods, no associations were found for reattendance to EMS. After adjustment for clinical presentation and acuity, VVED referral was associated with a 16-fold (adjusted OR: 15.97 95% CI 15.53 to 16.43) increase in the odds of non-transport. Among the 8.9% of patients who responded to the survey, satisfaction of the VVED was high (91.1%).
CONCLUSION: The EMS-VVED referral pathway contributed to significant improvements in ambulance non-transports and case-time savings.
PubMed:41276288 | DOI:10.1136/emermed-2025-214861