What is a virtual emergency department? And when should you ‘visit’ one?
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For many Australians the emergency department (ED) is the physical and emblematic front door to accessing urgent health-care services.
But health-care services are evolving rapidly to meet the population’s changing needs. In recent years, we’ve seen growing use of telephone, video, and online health services, including the national healthdirect helpline, 13YARN (a crisis support service for First Nations people), state-funded lines like 13 HEALTH, and bulk-billed telehealth services, which have helped millions of Australians to access health care on demand and from home.
The ED is similarly expanding into new telehealth models to improve access to emergency medical care. Virtual EDs allow people to access the expertise of a hospital ED through their phone, computer or tablet.
All Australian states and the Northern Territory have some form of virtual ED at least in development, although not all of these services are available to the general public at this stage.
So what is a virtual ED, and when is it appropriate to consider using one?
How does a virtual ED work?
A virtual ED is set up to mirror the way you would enter the physical ED front door. First you provide some basic information to administration staff, then you are triaged by a nurse (this means they categorise the level of urgency of your case), then you see the ED doctor. Generally, this all takes place in a single video call.
In some instances, virtual ED clinicians may consult with other specialists such as neurologists, cardiologists or trauma experts to make clinical decisions.
A virtual ED is not suitable for managing medical emergencies which would require immediate resuscitation, or potentially serious chest pains, difficulty breathing or severe injuries.
A virtual ED is best suited to conditions that require immediate attention but are not life-threatening. These could include wounds, sprains, respiratory illnesses, allergic reactions, rashes, bites, pain, infections, minor burns, children with fevers, gastroenteritis, vertigo, high blood pressure, and many more.
People with these sorts of conditions and concerns may not be able to get in to see a GP straight away and may feel they need emergency advice, care or treatment.
When attending the ED, they can be subject to long wait times and delayed specialist attention because more serious cases are naturally prioritised. Attending a virtual ED may mean they’re seen by a doctor more quickly, and can begin any relevant treatment sooner.
From the perspective of the health-care system, virtual EDs are about redirecting unnecessary presentations away from physical EDs, helping them be ready to respond to emergencies. The virtual ED will not hesitate in directing callers to come into the physical ED if staff believe it is an emergency.
The doctor in the virtual ED may also direct the patient to a GP or other health professional, for example if their condition can’t be assessed visually, or if they need physical treatment.
The results so far
Virtual EDs have developed significantly over the past three years, predominantly driven by the COVID pandemic. We are now starting to slowly see assessments of these services.
A recent evaluation my colleagues and I did of Queensland’s Metro North Virtual ED found roughly 30% of calls were directed to the physical ED. This suggests 70% of the time, cases could be managed effectively by the virtual ED.
Preliminary data from a Victorian virtual ED indicates it curbed a similar rate of avoidable ED presentations – 72% of patients were successfully managed by the virtual ED alone. A study on the cost-effectiveness of another Victorian virtual ED suggested it has the potential to generate savings in health-care costs if it prevents physical ED visits.
Only 1.2% of people assessed in Queensland’s Metro North Virtual ED required unexpected hospital admission within 48 hours of being “discharged” from the virtual ED. None of these cases were life-threatening. This indicates the virtual ED is very safe.
The service experienced an average growth rate of 65% each month over a two-year evaluation period, highlighting increasing demand and confidence in the service. Surveys suggested clinicians also view the virtual ED positively.
What now?
We need further research into patient outcomes and satisfaction, as well as the demographics of those using virtual EDs, and how these measures compare to the physical ED across different triage categories.
There are also challenges associated with virtual EDs, including around technology (connection and skills among patients and health professionals), training (for health professionals) and the importance of maintaining security and privacy.
Nonetheless, these services have the potential to reduce congestion in physical EDs, and offer greater convenience for patients.
Eligibility differs between different programs, so if you want to use a virtual ED, you may need to check you are eligible in your jurisdiction. Most virtual EDs can be accessed online, and some have direct phone numbers.
Jaimon Kelly, Senior Research Fellow in Telehealth delivered health services, The University of Queensland
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Green Tea Allergies and Capsules
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It’s Q&A Day at 10almonds!
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝Hey Sheila – As always, your articles are superb !! So, I have a topic that I’d love you guys to discuss: green tea. I used to try + drink it years ago but I always got an allergic reaction to it. So the question I’d like answered is: Will I still get the same allergic reaction if I take the capsules ? Also, because it’s caffeinated, will taking it interfere with iron pills, other vitamins + meds ? I read that the health benefits of the decaffeinated tea/capsules are not as great as the caffeinated. Any info would be greatly appreciated !! Thanks much !!❞
Hi! I’m not Sheila, but I’ll answer this one in the first person as I’ve had a similar issue:
I found long ago that taking any kind of tea (not herbal infusions, but true teas, e.g. green tea, black tea, red tea, etc) on an empty stomach made me want to throw up. The feeling would subside within about half an hour, but I learned it was far better to circumvent it by just not taking tea on an empty stomach.
However! I take an l-theanine supplement when I wake up, to complement my morning coffee, and have never had a problem with that. Of course, my physiology is not your physiology, and this “shouldn’t” be happening to either of us in the first place, so it’s not something there’s a lot of scientific literature about, and we just have to figure out what works for us.
This last Monday I wrote (inspired in part by your query) about l-theanine supplementation, and how it doesn’t require caffeine to unlock its benefits after all, by the way. So that’s that part in order.
I can’t speak for interactions with your other supplements or medications without knowing what they are, but I’m not aware of any known issue, beyond that l-theanine will tend to give a gentler curve to the expression of some neurotransmitters. So, if for example you’re talking anything that affects that (e.g. antidepressants, antipsychotics, ADHD meds, sleepy/wakefulness meds, etc) then checking with your doctor is best.
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Parent Effectiveness Training – by Dr. Thomas Gordon
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Do you want your home (or workplace, for that matter) to be a place of peace? This book literally got the author nominated for a Nobel Peace Prize. Can’t really get much higher praise than that.
The title is “Parent Effectiveness Training”, but in reality, the advice in the book is applicable to all manner of relationships, including:
- romantic relationships
- friends
- colleagues
- …and really any human interaction.
It covers some of the same topics we did today (and more) in much more detail than we ever could in a newsletter. It lays out formulae to use, gives plenty of examples, and/but is free from undue padding.
- Pros: this isn’t one of those “should have been an article” books. It has so much valuable content.
- Cons: It is from the 1970s* so examples may feel “dated” now.
In addition to going into much more detail on some of the topics covered in today’s issue of 10almonds, Dr. Gordon also talks in-depth about the concept of “problem-ownership”.
In a nutshell, that means: whose problem is a given thing? Who “has” what problem? Everyone needs to be on the same page about everyone else’s problems in the situation… as well as their own, which is not always a given!
Dr. Gordon presents, in short, tools not just to resolve conflict, but also to pre-empt it entirely. With these techniques, we can identify and deal with problems (together!) well before they arise.
Everybody wins.
Get your copy of “Parent Effectiveness Training” from Amazon today!
*Note: There is an updated edition on the market, and that’s what you’ll find upon following the above link. This reviewer (hi!) has a battered old paperback from the 1970s and cannot speak for what was changed in the new edition. However: if the 70s one is worth more than its weight in gold (and it is), the new edition is surely just as good, if not better!
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Radical CBT
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Radical Acceptance!
A common criticism of Cognitive Behavioral Therapy (CBT) is that much of it hinges on the following process:
- You are having bad feelings
- Which were caused by negative automatic thoughts
- Which can be taken apart logically
- Thus diffusing the feelings
- And then feeling better
For example:
- I feel like I’m an unwanted burden to my friend
- Because he canceled on me today
- But a reasonable explanation is that he indeed accidentally double-booked himself and the other thing wasn’t re-arrangeable
- My friend is trusting me to be an understanding friend myself, and greatly values my friendship
- I feel better and look forward to our next time together
But what if the negative automatic thoughts are, upon examination, reasonable?
Does CBT argue that we should just “keep the faith” and go on looking at a cruel indifferent world through rose-tinted spectacles?
Nope, there’s a back-up tool.
This is more talked-about in Dialectic Behavior Therapy (DBT), and is called radical acceptance:
Click Here If The Embedded Video Doesn’t Load automatically!
Radical acceptance here means accepting the root of things as true, and taking the next step from there. It follows a bad conclusion with “alright, and now what?”
“But all evidence points to the fact that my friend has been avoiding me for months; I really can’t ignore it or explain it away any longer”
“Alright. Now what?”- Maybe there’s something troubling your friend that you don’t know about (have you asked?)
- Maybe that something is nothing to do with you (or maybe it really is about you!)
- Maybe there’s a way you and he can address it together (how important is it to you?)
- Maybe it’s just time to draw a line under it and move on (with or without him)
Whatever the circumstances, there’s always a way to move forwards.
Feelings are messengers, and once you’ve received and processed the message, the only reason to keep feeling the same thing, is if you want to.
Note that this is true even when you know with 100% certainty that the Bad Thing™ is real and exactly as-imagined. It’s still possible for you to accept, for example:
“Alright, so this person really truly hates me. Damn, that sucks; I think I’ve been nothing but nice to them. Oh well. Shit happens.”
Feel all the feelings you need to about it, and then decide for yourself where you want to go from there.
Get: 25 CBT Worksheets To Help You Find Solutions To A Wide Variety of Problems
Recognizing Emotions
We talked in a previous edition of 10almonds’ Psychology Sunday about how an important part of dealing with difficult emotions is recognizing them as something that you experience, rather than something that’s intrinsically “you”.
But… How?
One trick is to just mentally (or out loud, if your current environment allows for such) greet them when you notice them:
- Hello again, Depression
- Oh, hi there Anxiety, it’s you
- Nice of you to join us, Anger
Not only does this help recognize and delineate the emotion, but also, it de-tooths it and recognizes it for what it is—something that doesn’t actually mean you any harm, but that does need handling.
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No-Frills, Evidence-Based Mindfulness
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What’s on your mind, really?
We hear a lot about “the evidence-based benefits of mindfulness”, but what actually are they? And what is the evidence? And, perhaps most importantly: how do we do it?
What are the benefits?
The benefits of mindfulness are many, and include:
- reducing stress
- reducing pain
- improving quality of life
- reducing fatigue
- providing relief from digestive disorders
- reducing symptoms of sleep disorders
- improving immune response
- providing support for caregivers
The evidence is also abundant, and includes:
- Effects of mindfulness exercises as stand-alone intervention on symptoms of anxiety and depression: Systematic review and meta-analysis
- Fusing character strengths and mindfulness interventions: Benefits for satisfaction and performance
- Evidence for the Role of Mindfulness in Cancer: Benefits and Techniques
- Effects of mindfulness-based stress reduction on anxiety symptoms: A systematic review and meta-analysis
- The benefits of meditation and mindfulness practices during times of crisis such as COVID-19
Sounds great… What actually is it, though?
Mindfulness is the state of being attentive to one’s mind. This is at its heart a meditative practice, but that doesn’t necessarily mean you have to be sitting in the lotus position with candles—mindfulness can be built into any daily activity, or even no activity at all.
An exercise you can try right now:
Take a moment to notice everything you can hear. For this writer, that includes:
- The noise of my keystrokes as I type
- The ticking of the clock on the wall
- The gentle humming of my computer’s processor
- The higher-pitched noise of my computer’s monitor
- Birdsong outside
- Traffic further away
- My own breathing
- The sound of my eyelids as I blink
Whatever it is for you, notice how much you can notice that you had previously taken for granted.
You can repeat this exercise with other senses, by the way! For example:
- Notice five things you can see in your immediate environment that you’ve never noticed before. If you’re at home reading this, you probably think you’re very familiar with everything around you, but now see that mark on the wall you’d never noticed before, or a quirk of some electrical wiring, or the stitching on some furnishing, for example.
- Notice the textures of your clothes, or your face, or perhaps an object you’ve never paid attention to touching before. Your fingertips, unless you have some special reason this doesn’t apply to you, are far more sensitive than you probably give them credit for, and can notice the tiniest differentiation in textures, so take a moment to do that now.
- Mindful eating can be an especially healthful practice because it requires that we pay every attention to what we’re putting in our mouth, tasting, chewing, swallowing. No more thoughtlessly downing a box of cookies; every bite is now an experience. On the one hand, you’ll probably eat less at a sitting. On the other hand, what a sensory experience! It really reminds one that life is for living, not just for zipping through at a speed-run pace!
What about mindfulness as a meditative practice?
Well, those are meditative practices! But yes, mindfulness goes for more formal meditation too. For example:
Sit comfortably, with good posture, whatever that means to you. No need to get too caught up in the physical mechanics here—it’d take a whole article. For now, if you’re sitting and comfortable, that’s enough.
Notice your breathing. No need to try to control it—that’s not what this is about today. Just notice it. The in, the out, whether you breathe to your chest or abdomen, through your nose or mouth, don’t worry about doing it “right”, just notice what you are doing. Observe without judgement.
Notice your thoughts—no need to try to stop them. Notice noticing your thoughts, and again, observe without judgement. Notice your feelings; are you angry, hopeful, stressed, serene? There are no wrong answers here, and there’s nothing you should try to “correct”. Just observe. No judgement, only observe. Watch your thoughts, and watch your thoughts go.
Did you forget about your breathing while watching your thoughts? Don’t worry about that either if so, just notice that it happened. If you have any feelings about that, notice them too, and carry on observing.
We go through so much of our lives in “autopilot”, that it can be an amazing experience to sometimes just “be”—and be aware of being.
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Apple vs Pineapple – Which is Healthier?
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Our Verdict
When comparing apple to pineapple, we picked the pineapple.
Why?
An apple a day may keep the doctor away, but pineapples are heavier and armored and spiky and generally much more intimidating.
More seriously, apples are great but we say pineapples have the better nutritional and phytochemical properties overall:
In terms of macros, actually apples win this first round, albeit marginally; the two fruits are equal on carbs, while apple has a little more fiber and pineapple has a (very) little more protein. This makes the fiber content the deciding factor, so apples do win this one, even if by just 1g/100g difference.
When it comes to vitamins, however, apples have more of vitamins E and K, while pineapple has more of vitamins A, B1, B2, B3, B5, B6, B7, B9, C, and choline. The margins of difference are equally generous on both sides, so this is a clear and overwhelming win for pineapple (including 10x more vitamin C than apples, which are themselves considered a good source of vitamin C)
In the category of minerals, apples have slightly more phosphorus, and pineapple has a lot more calcium, copper, iron, magnesium, manganese, potassium, selenium, and zinc. Another easy win for pineapple.
Pineapples are not only also higher in polyphenols, but also contain bromelain, a powerful anti-inflammatory group of enzymes that are unique to pineapple—you can read about it in the link below!
Meanwhile, pineapple wins the day in our head-to-head here, but as ever when it comes to a plurality of healthy things, do enjoy either or both! Diversity is good.
Want to learn more?
You might like to read:
Bromelain vs Inflammation & Much More
Enjoy!
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Best Salt for Neti Pots?
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❓ Q&A With 10almonds Subscribers!
Q: What kind of salt is best for neti pots?
A: Non-iodised salt is usually recommended, but really, any human-safe salt is fine. By this we mean for example:
- Sodium chloride (like most kitchen salts),
- Potassium chloride (as found in “reduced sodium” kitchen salts), or
- Magnesium sulfate (also known as epsom salts).
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