A Virtual Emergency Department Reduces Unnecessary Transfers to Hospital of Residential Aged Care Residents Who Fall With Headstrike

Abstract

Objective: To describe the effectiveness of the Victorian Virtual Emergency Department (VVED) in reducing unnecessary transfers to hospital of patients who fall with head strike in Residential Aged Care Facilities (RACFs). Methods: A retrospective cohort study of patients aged 65 and over residing in RACFs in Northern Melbourne who presented to the VVED with a fall and headstrike between May 2022 and June 2024. VVED referrals were categorised as from: (i) onscene Paramedic (VAM); (ii) nurse at RACF (VRACF); or (iii) diverted Emergency Services call (VACRA). Results: Two hundred and sixty patients (55.8% female; mean age 86 years) had a fall and headstrike. A similar number of patients were taking anticoagulant (20.8%) or antiplatelet medications (23.9%). The overall rate of transfer to hospital was 24.2% (63 of 260 patients) (VACRA 29.7%, VAM 28.2%, VRACF 18.0%). Anticoagulant use increased the likelihood of transfer (OR: 5.64, 95% CI: 2.81–9.35, p < 0.001). Chart review was performed on 42 of 63 patients transferred to hospital. CT Head was performed on 36 patients (86%) with one patient (2.8%) reported to have an intracranial haemorrhage. Eight patients (19%) were admitted with no patients requiring surgical intervention. No patients remaining at the RACF had an unexpected death related to their presentation at 7 days post-VVED consultation. Conclusions: Prehospital consultation with a Virtual Emergency Department for RACF residents who present with a fall and head strike can lead to a reduction in ambulance transfers to a physical ED without compromising safety.