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Original research
Study of prehospital video telehealth for callers with mental health-related complaints
  1. Emily Nehme1,2,
  2. Nicole Magnuson1,
  3. Lindsay Mackay3,
  4. Gareth Becker3,
  5. Mark Wilson4,
  6. Karen Smith2,5
  1. 1 Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia
  2. 2 School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
  3. 3 Operational Triage Services, Ambulance Victoria, Doncaster, Victoria, Australia
  4. 4 Imperial College Biomedical Research Centre, St Mary’s Hospital, London, UK
  5. 5 Department of Paramedicine, Monash University, Melbourne, Victoria, Australia
  1. Correspondence to Emily Nehme, Centre for Research and Evaluation, Ambulance Victoria, Doncaster, VIC 3130, Australia; emily.nehme{at}ambulance.vic.gov.au

Abstract

Background Patients 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.

Methods This 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.

Results A 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.

Conclusion The 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.

  • mental health
  • emergency ambulance systems
  • emergency care systems
  • communications
  • triage

Data availability statement

Data are available upon reasonable request. Data are available upon reasonable request to the corresponding author.

https://doi.org/10.1136/emermed-2022-212456

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    Data availability statement

    Data are available upon reasonable request. Data are available upon reasonable request to the corresponding author.

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    Footnotes

    • Handling editor Ellen J Weber

    • Contributors KS conceived the study. NM, EN and GB collected the data. EN conducted the literature search, drafted the manuscript, performed the statistical analyses and acts as guarantor of the work. All authors contributed to data interpretation, reviewed the manuscript and made critical revisions for intellectual property.

    • Funding The Tele-HELP study received funding from the Safer Care Victoria Innovation Fund (IFI9104). EN is supported by a National Health and Medical Research Council (NHMRC) Postgraduate Scholarship (2003449).

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.