Aims:
Virtual Emergency Medicine (VEM) is a novel consult service which facilitates assessment of patients in the community by an emergency physician after an ambulance visit. The Rapid Access Treatment Unit (RATU) for geriatric medicine has collaborated with the VEM team to facilitate direct admissions to our unit of suitable geriatric patients, bypassing ED.
The aims of this study were to determine feasibility of the pathway, determine patient cohort admitted via VEM and determine outcomes including length of stay (LOS), discharge destination and hospital acquired complications.
Methods:
Data related to VEM patients (collected by interrogation of the electronic medical record (EMR)) included demographics, admission diagnosis, discharge destination, presence of delirium or dementia, unexpected readmission within 30 days, clinical frailty scale (CFS) and development of hospital acquired complications. Data was compared with other patients on the same ward.
Results:
137 patients were admitted directly to RATU via the VEM pathway in 2022. These patients represented a frail, elderly cohort with an average CFS of 5.7 and an average age of 84.3 years. 4.3% returned to tertiary care at some point during admission. Most lived at home (86%) and most (78.9%) returned to their usual residence. Complication rates were relatively low with 2.1% developing in-hospital delirium. 6 (4.3%) required transfer for tertiary care. Patient/carer satisfaction was extremely high with this pathway.
Conclusion:
VEM can be used to triage frail elderly patients to an acute geriatric ward, bypassing ED, with positive outcomes and low rates of complications in an otherwise vulnerable cohort.