The NSW Ambulance Virtual Clinical Care Centre supports consumers and paramedics via a 24/7 service that aims to deliver care at the right time, in the right place and by the right clinician.
When primary triage identifies a consumer doesn’t need an ambulance immediately, they are referred to the Virtual Clinical Care Centre (VCCC) to be assessed. While waiting for the ambulance to arrive, a VCCC clinician initiates a ‘call back’ and secondary triage to understand the consumer’s needs. This ensures the consumer is either:
- provided with self-care advice to safely manage their condition at home
- referred to the most appropriate care provider
- given information and reassured while they wait for the NSW Ambulance paramedic to attend.
VCCC team members include:
- registered paramedics
- paramedic specialists
- registered nurses
- clinical nurse consultants
- doctors.
These clinicians combine their knowledge and experience and can use videoconferencing during the secondary triage. A strong clinical governance framework ensures safe and consistent assessment of each consumer.
VCCC secondary triage and overview
Reasons for change
- A Triple Zero (000) call is made around every 22 seconds in NSW.
- NSW Ambulance Control Centre staff triage more than 1.2 million Triple Zero calls a year.
- More than 50% of calls are non-emergency.
- NSW Ambulance, emergency departments and the healthcare system have limited resources.
- High volume of calls leads to extended wait times and increases the risk of clinical deterioration or longer recovery times.
Consumer experience
Advice provided: A mother called Triple Zero when her eight-year-old son stepped on broken glass. Primary triage identified this as low acuity. A VCCC clinician completed a secondary triage call back that included looking at the wound via videoconferencing using the GoodSAM platform. The clinician saw no active bleeding or neurovascular changes. They supported the mother to provide basic first aid. The ambulance was cancelled.
Referral arranged: A man, aged 73, called Triple Zero concerned that a painful lump in his leg might be a blood clot. During secondary triage, he was advised about pain relief, to elevate the leg and minimise movement. With his consent, he was referred to the Central Coast Local Health District@Home (CCH@H) service. The CCH@H arranged an appointment the next day. They diagnosed that the pain was related to osteoarthritis. The consumer was supported to remain at home until his leg and mobility improved.
Incident escalated: An ambulance was requested after a nursing home resident had an unwitnessed fall. A VCCC clinician initiated a call back and prompted the on-site nurse to complete a full set of vitals and neurological observations. The results indicated clinical deterioration. The clinician escalated the primary triage category of the incident to ensure timely treatment.
Triage pathways
Treat at home
Many consumers don’t require an ambulance to attend or to be transported to an emergency department (ED). They are provided with self-care advice so they can remain at home and manage their condition safely. The VCCC cancels the ambulance. This ensures resources are available for more urgent cases.
Refer to care provider
Many consumers are only aware of the traditional ambulance to ED treatment pathway. VCCC clinicians use their clinical judgement and statewide referral service database to connect consumers with appropriate alternative pathways. Consumers are referred to their GP, urgent care centres or services, pharmacies or other local healthcare services and their scheduled ambulance is cancelled.
Extended care paramedics
VCCC recommends targeted dispatch of extended care paramedics (ECPs) to treat consumers at home. ECPs are single NSW Ambulance responders who can treat a range of low acuity incidents. After successful referral, the VCCC cancels the scheduled emergency ambulance.
Collect information
When the VCCC secondary triage identifies a consumer who requires an ambulance, the VCCC clinician calls back to request additional information. This reassures the consumer. It also assists NSW Ambulance Control Centre staff to make safe dispatch decisions and ensure a clinically appropriate timeframe is allocated. Paramedics are given clinical information to prepare them before they arrive.
Clinician to clinician advice
A multidisciplinary team provides a centralised point for clinical support and advice to on-site paramedics across specialties. This enables on-site clinicians to treat consumers more confidently and safely at home. It also reduces the number of consumers transported to EDs.
Key enablers
- Using GoodSAM videoconferencing allows on-demand video calls. Links are sent via SMS or email, providing a one-touch connection for consumers or carers with appropriate devices. VCCC clinicians can see the consumer and safely instruct and supervise treatment.
- Integration with NSW Ambulance Computer Aided Dispatch system.
- Access to healthcare records to support informed decision making and continuity of care, where possible.
- Single point of access.
- Consistency across various districts and public health networks.
- Visibility of capacity and streamlined handover process.
- NSW Ambulance partners with HealthShare NSW Patient Transport Services (PTS) to implement a referral system for PTS transport when clinically appropriate and PTS capacity allows.
- Pilot is underway for taxi transport to help consumers access referral pathways when there are no other transport options.
Outcomes
- Improved consumer outcomes
- Increased consumer safety
- Reduced waiting time for treatment
- Improved consumer experience
- Reduced emergency department admissions
- Reduction in hospital ramping (time ambulances wait to off-load consumers)
- Better resource allocation means emergency resources are available for the consumers who need them most
- Clinician education through exposure to multidisciplinary advice
Acknowledgement
We acknowledge the NSW Ambulance and Virtual Clinical Care Centre staff for their support and information provided for this Spotlight.