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

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.