Virtual board rounds reducing clinical risk and improving operational outcomes
My Emergency Doctor’s Virtual Board Rounds innovation provides senior clinical support and supervision, empowering junior doctors to deliver expert, timely care while building their skills. Risk is reduced and clinical and operational outcomes improved through better patient flow and minimising unnecessary admissions and diagnostic investigations.
Consistent, high-quality board rounds are emerging as a highly beneficial support and training mechanism for junior doctors, enhancing patient flow to reduce pressure on facilities and deliver better patient outcomes. However, with traditional in-person board rounds being reliant on having a senior emergency specialist on-site, this option is usually not available in regional facilities like Wimmera Base Hospital – particularly during the overnight space.
Supporting clinical teams overnight
Wimmera Base Hospital provides a range of emergency, acute, sub-acute, allied health and primary care services. Part of Wimmera Health Care Group, it serves a population of approximately 54,000 in Victoria’s Wimmera and Southern Mallee regions, 310 kilometres west of Melbourne.
In the past, the Horsham- based campus had brought in emergency physicians from major Melbourne hospitals to cover the overnight shift in its 24-hour emergency department. More recently, however, it has relied upon locum doctors working with a registered nurse in charge.
However with many of those locum doctors still relatively junior, access to a senior emergency specialist for support and supervision overnight, every night, is crucial to reducing risk and improving clinical and operational outcomes with the timeliness of specialist clinical decisions. This is where My Emergency Doctor (MED) and its Virtual Board Rounds solution – a world first in the application of telehealth – comes in.
FACEM-led integrated care
MED’s Virtual Board Rounds service provides specialist Australian-qualified emergency physicians (FACEMs) to lead and support junior medical staff with critical care decisions on-site, particularly after hours.
Since April 2021, Wimmera Base Hospital’s junior locum doctors have been meeting via video call with a MED FACEM three times nightly during the overnight shift – at 11pm, 2am and 6am. They discuss patient cases, review investigations, interpret results, and decide on treatment plans and whether a patient should be discharged, admitted, or transferred.
Dr William Hargreaves is a five-year postgraduate doctor who spent four months at Horsham covering nights in the ED. Having previously worked in larger emergency departments in Melbourne, Ballarat and Bendigo, he says virtual access to a senior physician has been exceedingly valuable.
“Working in larger hospitals, I would see a patient and then speak to the emergency consultant for advice, so having access to MED doctors virtually throughout every shift, effectively replaces that crucial support and learning opportunity,” says Hargreaves.
“There’s a significant knowledge and experience gap between a junior doctor and one of MED’s senior emergency specialists. They always take the opportunity to teach. And when a patient is really unwell, they can provide expert advice on acute management and what to look out for.”
Hargreaves says it is particularly beneficial in deciding whether a patient should be admitted, and in interpreting tests – such as radiology scans, bloodwork and ECGs – where a more experienced eye may see something easily missed.
“ECG tracings can be quite nuanced, and there can be very minute changes that could mean someone is having a serious heart attack. There have been cases where the emergency specialist has picked up on a marker that has changed how, and how quickly, we act and whether we speak to the cardiology team in Ballarat for advice.”
Safer, faster and more efficient
Empowering clinical teams to make good decisions quickly reduces risks and improves clinical and operational outcomes by preventing overcrowded waiting rooms and reducing wait times, medical errors and the potential for unnecessary investigations or admissions.
Virtual Board Round provides clear and immediate benefits – not only for patients, doctors and nurses, but for the facility’s operational and financial performance.
“Better decision-making about who can go home safely and who needs to come into hospital has huge flow-on effects. If the wards are full of patients who don’t need to be there, we have a situation where the ED is filled with patients waiting for beds, which means wait times blow out and patient outcomes can decline,” Hargreaves says.
“Having the support through the board rounds contributes to better patient flow across the hospital. And having telehealth access to emergency specialist doctors means we don’t need to wake the on-call doctor, who will probably be working the next morning, if we just need advice.”