Resources New Hybrid Healthcare Model Supports Overwhelmed EDs and Rural Health Pictured are three of the founding team: Dr Martyn Harvey (Clinical Director), Jenni Falconer (CEO), and Dr Giles Chanwai (Emergency Medicine Specialist). New hybrid healthcare model supports overwhelmed EDs and Rural Health Witnessing their Emergency Departments (ED) struggle under the pressures of growing numbers of patients, a group of ED clinicians founded a telehealth emergency consultation service in 2019. Jenni Falconer, a former ED nurse and three Emergency Medicine Specialist (FACEM) colleagues, had reached a point where they could see that the existing model alone wasn’t coping with demand. They looked internationally at how telehealth was being used by organisations in the UK and Australia to provide an alternative route to care. Initially they set out to offer consults direct to the general public, but quickly recognised they could help more people, in more ways, by also partnering with other health and care providers. One of the first partnerships was with a chain of travel clinics. The intention was to support the urgent medical needs of New Zealanders travelling overseas – but the arrival of Covid-19 stopped that initiative early on. Undeterred, the team continued to refine their telehealth offering; taking calls from every day New Zealanders, as well as partnering with pharmacies, isolation facilities, and aged care providers to provide rapid, remote medical assessment. “While Covid was undoubtedly very hard on the world, one positive consequence is that it opened up the way for telehealth to gain traction,” says Jenni Falconer, CEO at Emergency Consult. “Prior to the pandemic, having a consultation with a medical professional over the phone or a video link was unusual but through the pandemic, people became used to it as a means to getting care.” The team at Emergency Consult also started providing telehealth Covid support. Experienced Registered Nurses (RNs) were recruited to support various DHBs across the country manage Covid in the community through remote consults and follow-ups. Before long the company had grown to include three core services: a nursing service that supports aged residential care facilities, acute care triage, and emergency doctors. The range of healthcare providers supported by Emergency Consult has continued to expand and now includes EDs, rural health clinics and ambulance services. Smaller rural EDs have benefited from the arrangement, which enables them to better manage surges in demand, after-hours staffing, and doctor shortages. “During Covid, it became particularly hard for smaller EDs to get locums when they needed them but Emergency Consult could provide cover so that the on-call Senior Medical Officer (SMO) would only get called out if we saw the need for a physical examination,” says Jenni. “Sometimes the on-call doctor might be 20 minutes away and our team can support the patient virtually until the doctor arrives.” For everyday Kiwi’s, Emergency Consult is also available as a “user pays” service. “For parents with small kids, for example, this allows you to access care in middle of the night without having to load everyone in the car or waiting around in a busy waitroom,” says Jenni. “We estimate that, of the cases we see virtually, 85% can be dealt with appropriately via telehealth. For the final 15%, we can do a referral to the local hospital so the patient can turn up and be seen straight away.” Emergency Consult also recently completed a pilot with St John Ambulance where the Emergency Consult doctors worked with the paramedics on site to assess and treat patients during a callout. Together the doctor and paramedic would determine the severity of the case and whether a trip to the hospital is required. The pilot revealed that out of 1000 callouts, 800 patients were able to be treated at home with the combination of paramedic and telehealth support. “This potentially has a massive impact on frontline delivery and can make a real difference to workload of overwhelmed ED staff.” The biggest challenge facing Emergency Consult at this early phase of telehealth adoption in New Zealand is the fact this service doesn’t fit in with traditional healthcare models as supported by ACC. However, having grown from a team of 4 to over 70 staff (who all work within the traditional healthcare sector when not working shifts for Emergency Consult), the Emergency Consult team have proved this model can work well as an adjunct to support the health system. “We have been asked whether this is a way to save money but it’s not about that – it’s about survival and keeping this workforce going. With the shortages we have in staffing across the health sector, we need a hybrid model which can open access to care for the patients and help prevent our ED staff burning out,” says Jenni.
