WA’s new virtual triple-0 call system the ‘future’ of elderly care to avoid unnecessary trips to hospital ED

Aged-care residents who become unwell will be consulted virtually prior to an ambulance being called in a bid to avoid unnecessary emergency department presentations and slash ramping hours this winter. The new system — which will initially operate across Perth’s northern and eastern suburbs — has been labelled “the future” by Health Minister Amber-Jade Sanderson as she seeks to better leverage digital technology to ease the pressure on overflowing public hospitals. It has arisen from a ministerial task force established by Ms Sanderson last year that has been investigating a range of ways to drive down record levels of ambulance ramping. Ms Sanderson said half of WA’s ramping hours were among patients aged 70 and over, the vast majority of whom were transferred to hospital from aged care facilities. In 2022, ambulances spent more than 66,000 hours struck outside hospitals — the worst ramping figure ever recorded in the state. “One of the things we see now is because aged care is so understaffed and underskilled, those staff are not empowered or skilled enough to make assessments about their residents and they just call ambulances,” she said. “St John make them (priority one) and then they arrive at the triage desk and (hospital staff) go ‘This is not a P1’ and that’s why they end up with the long wait. So we’re trying to avoid that.” The new system — which has been funded to the tune of $40 million — will establish a dedicated, 24/7 hotline for aged care facility staff to contact hospitals in the North and East Metropolitan Health Service catchments. The phone will be manned by a hospital-based consultant and registered nurse tasked with triaging the patient before an ambulance is called. In non-emergencies, that may involve arranging a specialist appointment or direct ward admission at the relevant hospital that would avoid a trip to the ED altogether. In some instances, a doctor or nurse may also be dispatched to the aged care facility to provide treatment on-site. The South Metropolitan Health Service already operates a similar system — based out of Fiona Stanley Hospital — but in a different format, which involves patients that have been collected by an ambulance being consulted and triaged on their way into the hospital and diverted from ED where appropriate. A leaked informal memo from a meeting of the Fiona Stanley Fremantle Hospital Group leadership team earlier this month discussed a “radical new approach” being discussed with the Health Department that sought to integrate hospital care into the community. “It is a way to reduce demand and ensure patients post-treatment have a safe place to be discharged, or, suggests virtual/hospital in the home wards,” the document read. “Virtual wards and clinics will be developed with the journey for elderly and mental health patients having direct access to Fremantle rather than sitting in FSH ED then being transferred.” Ms Sanderson said the winter implementation of an aged care hospital hotline was the first step towards what will be known as the WA Virtual Emergency Department. Ultimately, one consistent model will be rolled out across the State and expanded beyond just aged care residents. “I think this will be challenging for some (health workers) who have practiced in a very traditional way, but by far and away this is the future,” Ms Sanderson said. “I expect to end up with a… system that can be scaled up for the community and eventually what you’d want is access for community members to be able to have a look on an app or call a phone line that isn’t Healthdirect — because Healthdirect send everyone to hospital.” Ms Sanderson is also currently going through the business case process for a new State Health Operations Centre — a key recommendation from last year’s ambulance services inquiry — which would centralise the new WA Virtual Emergency Department alongside ambulance dispatch and the coordination of outpatients. “I would like to that up and running by winter 2024 in its entirety,” she said. The Health Minister declined to nominate a target for falls in ambulance ramping over winter, saying only that she hoped to “have an impact and take a chunk out”. “There’s a risk for older people in hospitals, there’s risk of fall, risk of infection, bed sores,” Ms Sanderson said. “And so this is really about giving them the care they need. And if they need a hospital bed, they’ll get one. If they don’t, but they need access to care, then they’ll get that instead.” The Australian Nursing Federation slammed the new phone service as “window dressing” and “an inefficient use of critical health resources”, saying it would be better to send a nurse or doctor to an aged care facility to do a proper hands-on assessment. “Taking a consultant off the floor of ED and into a call room is a waste of expert clinical resources,” State secretary Janet Reah said. “Telehealth is not an appropriate method to assess and treat our elderly. They deserve better than a phone call.” Shadow Minister for Health Libby Mettam said she was worried the McGowan Government was attempting to “shift the blame of ambulance ramping onto sick, elderly” West Australians and under-resourced aged-care workers. “Telling our elderly not to call triple zero is not addressing the fundamental cause of ramping which is bed block in the system,” Ms Mettam said. “And how long does the Health Minister expect our sick aged-care residents to sit by the phone before getting the urgent medical attention they require?”