Study of prehospital video telehealth for callers with mental health-related complaints

Abstract

BackgroundPatients with mental health-related complaints are a key driver of increasing emergency medical service (EMS) demand; however, they require minimal intervention by EMS personnel. We describe the outcomes of a video telehealth study by mental health nurses (MHNs) in an EMS call-taking centre.MethodsThis was a prospective study of adult (≥18 years) EMS callers with non-urgent mental health concerns in Victoria, Australia who underwent secondary triage between 1 March 2020 and 31 May 2021. Multivariable logistic regression models were used to compare the influence of video telehealth with voice-only triage by an MHN or secondary triage practitioner on the need for ambulance dispatch. One-week follow-up was conducted with video telehealth patients. Interviews were conducted with MHNs and a cost analysis was performed.ResultsA total of 9588 patients were included of which 738 (7.7%) completed video consultation. The median age of video telehealth patients was 34 years (Q1: 24, Q3: 47), 62% were female and the most common complaint was suicidal or self-harm ideation (50.0%). After multivariable adjustment, video telehealth was associated with reduced odds of emergency ambulance dispatch (OR=0.173, 95% CI 0.144 to 0.209) when compared with voice-only triage by a secondary triage practitioner, but not voice-only triage by an MHN (OR=1.009, 95% CI 0.827 to 1.232). Video triage was associated with increased referrals to alternative services (excluding EDs) when compared with voice-only triage by an MHN (OR=1.321, 95% CI 1.087 to 1.606). Among those responding to 1-week follow-up, 92.8% were satisfied with the telehealth service and MHNs viewed it favourably. The average cost per video telehealth case was half that of a traditional secondary triage.ConclusionThe use of video telehealth by MHNs was associated with fewer emergency ambulance dispatches when compared with voice-only triage by secondary triage practitioners, and increased referrals to alternative services. This cost-effective technology was viewed favourably by patients and MHNs. Expansion of video technology in EMS call taking warrants exploration.

Refining ambulance clinical response models: The impact on ambulance response and emergency department presentations

“…Previous studies from Denmark have reported positive results and recommended its permanent implementation 22,23 . Locally, video triage by mental health nurses during secondary triage enables visual patient assessment and increased triage specificity 14 . The current study suggests that the expansion of video technology to a broader cohort of emergency callers should be piloted.…”

“…22,23 Locally, video triage by mental health nurses during secondary triage enables visual patient assessment and increased triage specificity. 14 The current study suggests that the expansion of video technology to a broader cohort of emergency callers should be piloted. It is plausible that visual assessment at the point of emergency call may alleviate demand on emergency ambulances 14 and nonemergency patient transport services.…”

“…The current study suggests that the expansion of video technology to a broader cohort of emergency callers should be piloted. It is plausible that visual assessment at the point of emergency call may alleviate demand on emergency ambulances 14 and non‐emergency patient transport services. Given that we observed the reduction in ED presentations via emergency ambulance to be offset by arrivals via non‐emergency transport, the use of video technology may also have flow‐on effects to the ED.…”

“…Triage outcomes include the dispatch of an emergency ambulance (Code 1, Code 2 or Code 3) or non‐emergency patient transport vehicle, referral to an alternative health service, advice to self‐present to an ED, or the provision of self‐care advice. Video triage by mental health nurses is also possible for patients with mental health‐related complaints 14 . Prior to 2016, approximately 10% of all metropolitan calls were diverted to secondary triage 15 …”

“…Dispatch priorities include Code Video triage by mental health nurses is also possible for patients with mental health-related complaints. 14 Prior to 2016, approximately 10% of all metropolitan calls were diverted to secondary triage. 15 In response to increasing demand and deteriorating response time performance, a revised CRM was developed and implemented in 2016.…”