Oral Presentation ESA-SRB-ANZBMS 2024 in conjunction with ENSA

Management of Fragility Fractures in a Virtual Emergency Department: A Retrospective, Population-Based Cohort Study (#236)

Jason Talevski 1 2 3 , Adam Semciw 1 3 , James Boyd 3 , Rebecca Jessup 1 3 , Jennie Hutton 1 2 3 , Suzanne Miller 1 2 , Joanna Lawrence 1 , Loren Sher 1 3
  1. Northern Health, Epping, VIC, Australia
  2. The University of Melbourne, Melbourne, VIC, Australia
  3. La Trobe University, Melbourne, VIC, Australia

Background: Embedding digital technologies into health care is a global priority to meet care demands of the healthcare system. The Victorian Virtual Emergency Department (VVED) was launched in October 2020 to deliver emergency specialist telehealth consultations to patients in the Northern Hospital's catchment area (Figure 1). Since expanding statewide in February 2022, the VVED has consulted with more than 350,000 patients across Victoria (currently averaging >750 daily presentations making it the busiest ED in the world). This study explored whether the VVED is associated with a reduction in hospital transfers from older patients following a fracture.

Methods: Data was retrospectively obtained from the VVED administrative dataset for patients aged >60 years coded with a diagnosis of a ‘fracture’ or ‘broken bone (excluding teeth)’ between June 2022-June 2024. Descriptive and multivariable logistic analyses were performed.

Results: There were 522 VVED presentations related to fractures during the study period (mean age: 80.6 years; 66.5% female; 86.3% born in Australia). Over 80% of fracture were at major osteoporotic fracture sites – hip, vertebrae, wrist or humerus. Majority of patients (52.5%) were referred from residential aged care, followed by urgent care centres (19.4%) and Ambulance paramedics (12.3%). Overall, only 211 patients (40.4%) were advised to transfer to a hospital. Data on hospital re-presentations within 72 hours of the VVED presentation and 30-day mortality will be presented (analyses with national linked data is in progress).

Conclusions: Approximately 75%-90% of aged care patients or older adults who call an ambulance after suffering a fracture are transferred to hospital (in line with clinical practice guidelines). This was reduced by over 30% in our study. The VVED model of care has reformed healthcare delivery in Australia by offering a secure, innovative, and convenient alternative to traditional emergency care that benefits both patient outcomes and healthcare resource allocation.

 

66b1631f56230-yayyyy.png