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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Procrastination, and how to pay off the to-do list debt
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Procrastination, and how pay off the to-do list debt
Sometimes we procrastinate because we feel overwhelmed by the mountain of things we are supposed to be doing. If you look at your to-do list and it shows 60 overdue items, it’s little wonder if you want to bury your head in the sand!
“What difference does it make if I do one of these things now; I will still have 59 which feels as bad as having 60”
So, treat it like you might a financial debt, and make a repayment plan. Now, instead of 60 overdue items today, you have 1/day for the next 60 days, or 2/day for the next 30 days, or 3/day for the next 20 days, etc. Obviously, you may need to work out whether some are greater temporal priorities and if so, bump those to the top of the list. But don’t sweat the minutiae; your list doesn’t have to be perfectly ordered, just broadly have more urgent things to the top and less urgent things to the bottom.
Note: this repayment plan means having set repayment dates.
Up front, sit down and assign each item a specific calendar date on which you will do that thing.
This is not a deadline! It is your schedule. You’ll not try to do it sooner, and you won’t postpone it for later. You will just do that item on that date.
A productivity app like ToDoist can help with this, but paper is fine too.
What’s important here, psychologically, is that each day you’re looking not at 60 things and doing the top item; you’re just looking at today’s item (only!) and doing it.
Debt Reduction/Cancellation
Much like you might manage a financial debt, you can also look to see if any of your debts could be reduced or cancelled.
We wrote previously about the “Getting Things Done” system. It’s a very good system if you want to do that; if not, no worries, but you might at least want to borrow this one idea….
Sort your items into:
Do / Defer / Delegate / Ditch
- Do: if it can be done in under 2 minutes, do it now.
- Defer: defer the item to a specific calendar date (per the repayment plan idea we just talked about)
- Delegate: could this item be done by someone else? Get it off your plate if you reasonably can.
- Ditch: sometimes, it’s ok to realize “you know what, this isn’t that important to me anymore” and scratch it from the list.
As a last resort, consider declaring bankruptcy
Towards the end of the dot-com boom, there was a fellow who unintentionally got his 5 minutes of viral fame for “declaring email bankruptcy”.
Basically, he publicly declared that his email backlog had got so far out of hand that he would now not reply to emails from before the declaration.
He pledged to keep on top of new emails only from that point onwards; a fresh start.
We can’t comment on whether he then did, but if you need a fresh start, that can be one way to get it!
In closing…
Procrastination is not usually a matter of laziness, it’s usually a matter of overwhelm. Hopefully the above approach will help reframe things, and make things more manageable.
Sometimes procrastination is a matter of perfectionism, and not starting on tasks because we worry we won’t do them well enough, and so we get stuck in a pseudo-preparation rut. If that’s the case, our previous main feature on perfectionism may help:
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How to Vary Breakfast for Digestion?
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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
❝Would appreciate your thoughts on how best to promote good digestion. For years, my breakfast has consisted of flaxseeds, sunflower seeds, and almonds – all well ground up – eaten with a generous amount of kefir. This works a treat as far as my digestion is concerned. But I sometimes wonder whether it would be better for my health if I varied or supplemented this breakfast. How might I do this without jeopardising my good digestion?❞
Sounds like you’re already doing great! Those ingredients are all very nutrient-dense, and grinding them up improves digestion greatly, to the point that you’re getting nutrients your body couldn’t get at otherwise. And the kefir, of course, is a top-tier probiotic.
Also, you’re getting plenty of protein and healthy fats in with your carbs, which results in the smoothest blood sugar curve.
As for variety…
Variety is good in diet, but variety within a theme. Our gut microbiota change according to what we eat, so sudden changes in diet are often met with heavy resistance from our gut.
- For example, people who take up a 100% plant-based diet overnight often spend the next day in the bathroom, and wonder what happened.
- Conversely, a long-time vegan who (whether by accident or design) consumes meat or dairy will likely find themself quickly feeling very unwell, because their gut microbiota have no idea what to do with this.
So, variety yes, but within a theme, and make any changes gradual for the easiest transition.
All in all, the only obvious suggestion for improvement is to consider adding some berries. These can be fresh, dried, or frozen, and will confer many health benefits (most notably a lot of antioxidant activity).
Enjoy!
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You Are the One You’ve Been Waiting For – by Dr. Richard Schwartz
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As self-therapy approaches go, the title here could be read two ways: as pop-psychology fluff, or a suggestion of something deeper. And, while written in a way to make it accessible to all, we’re happy to report the content consists of serious therapeutic ideas, presented clearly.
Internal Family Systems (IFS) is a large, internationally recognized, and popular therapeutic approach. It’s also an approach that lends itself quite well to self-therapy, as this book illustrates.
Dr. Schwartz kicks off by explaining not IFS, but the problem that it solves… We (most of us, anyway) have over the course of our lives tried to plug the gaps in our own unmet psychological needs. And, that can cause resentment, strain, and can even be taken out on others if we’re not careful.
The real meat of the book, however, is in its illustrative explanations of how IFS works, and can be applied by an individual. The goal is to recognize all the parts that make us who we are, understand what they need in order to be at peace, and give them that. Spoiler: most what they will need is just being adequately heard, rather than locked in a box untended.
One of the benefits of using this book for self-therapy, of course, is that it requires a lot less vulnerability with a third party.
But, speaking of which, what of these intimate relationships the subtitle of the book referenced? Mostly the benefits to such come from a “put your own oxygen mask on first” angle… but the book does also cover discussions between intimate partners, and approaches to love, including what the author calls “courageous love”.
Bottom line: this is a great book if you want to do some “spring-cleaning of the soul” and live a little more lightly as a result.
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Gut-Healthy Sunset Soup
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So-called for its gut-healthy ingredients, and its flavor profile being from the Maghreb (“Sunset”) region, the western half of the N. African coast.
You will need
- 1 can chickpeas (do not drain)
- 1 cup low-sodium vegetable stock
- 1 small onion, finely chopped
- 1 carrot, finely chopped
- 2 tbsp sauerkraut, drained and chopped (yes, it is already chopped, but we want it chopped smaller so it can disperse evenly in the soup)
- 2 tbsp tomato paste
- 1 tbsp harissa paste (adjust per your heat preference)
- 1 tbsp ras el-hanout
- ¼ bulb garlic, crushed
- Juice of ½ lemon
- ¼ tsp MSG or ½ tsp low-sodium salt
- Extra virgin olive oil
- Optional: herb garnish; we recommend cilantro or flat-leaf parsley
Method
(we suggest you read everything at least once before doing anything)
1) Heat a little oil in a sauté pan or similar (something suitable for combination cooking, as we’ll be frying first and then adding liquids), and fry the onion and carrot until the onion is soft and translucent; about 5 minutes.
2) Stir in the garlic, tomato paste, harissa paste, and ras el-hanout, and fry for a further 1 minute.
3) Add the remaining ingredients* except the lemon juice. Bring to the boil and then simmer for 5 minutes.
*So yes, this includes adding the “chickpea water” also called “aquafaba”; it adds flavor and also gut-healthy fiber in the form of oligosaccharides and resistant starches, which your gut microbiota can use to make short-chain fatty acids, which improve immune function and benefit the health in more ways than we can reasonably mention as a by-the-way in a recipe.
4) Stir in the lemon juice, and serve, adding a herb garnish if you wish.
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Our Top 5 Spices: How Much Is Enough For Benefits? ← today’s recipe scored 5/5 of these, plus quite a few more! Remember that ras el-hanout is a spice blend, so if you’re thinking “wait, where’s the…?” then it’s in the ras el-hanout 😉
- Making Friends With Your Gut (You Can Thank Us Later)
- Lycopene’s Benefits For The Gut, Heart, Brain, & More ← not to be underestimated!
Take care!
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The Pains That Good Posture Now Can Help You Avoid Later
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Dr. Murat Dalkilinç explains:
As a rule…
Posture is the foundation for all body movements and good posture helps the body adapt to stress.
Problems arise when poor posture causes muscles to overwork in ways that are not good for them, becoming tight or inhibited over time. Bad posture can lead to wear and tear on joints, increase accident risk, and make some organs (like the lungs, which feed everything else with the oxygen necessary for normal functioning) less efficient. It’s also of course linked to issues like scoliosis, tension headaches, and back pain, and can even affect emotions and pain sensitivity.
Good posture includes straight alignment of vertebrae when viewed from the front/back, and three natural curves in a (very!) gentle S-shape when viewed from the side. Proper posture allows for efficient movement, reduces fatigue, and minimizes muscle strain. For sitting posture, the neck should be vertical, shoulders relaxed, arms close to the body, and knees at a right angle with feet flat.
But really, one should avoid sitting, to whatever extent is reasonably possible. Standing is better than sitting; walking is better than standing. Movement is crucial, as being stationary for extended periods, even with good posture, is not good for our body.
Advices given include: adjust your environment, use ergonomic aids, wear supportive shoes, and keep moving. Regular movement and exercise keep muscles strong to support the body.
For more on all this, enjoy:
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Want to learn more?
You might also like to read:
Beyond Just Good Posture: 6 Ways To Look After Your Back
Take care!
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10 Oft-Ignored Symptoms Of Diabetes
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Due in part to its prevalence and manageability, diabetes is often viewed as more of an inconvenience than an existential threat. While very few people in countries with decent healthcare die of diabetes directly (such as by diabetic ketoacidosis, which is very unpleasant, and happens disproportionately in the US where insulin is sold with a 500%–3000% markup in price compared to other countries), many more die of complications arising from comorbidities, and as for what comorbidities come with diabetes, well, it increases your risk for almost everything.
So, while for most people diabetes is by no means a death sentence, it is something that means you’ll now have to watch out for pretty much everything else too. On which note, Dr. Siobhan Deshauer is here with things to be aware of:
More than your waistline
Some of these are early symptoms (even appearing in the prediabetic stage, so can be considered an early warning for diabetes), some are later risks (it’s unlikely you’ll lose your feet from diabetic neuropathy complications before noticing that you are diabetic), but all and any of them are good reason to speak with your doctor sooner rather than later:
- Polyuria: waking up multiple times at night to urinate due to excess glucose spilling into the urine.
- Increased thirst: dehydration from frequent urination leads to excessive thirst, creating a cycle.
- Acanthosis nigricans: dark, velvety patches on areas like the neck, armpits, or groin, signalling insulin resistance.
- Skin tags: multiple skin tags in areas of friction may indicate insulin resistance.
- Recurrent Infections: high blood sugar weakens the immune system, making skin infections, UTIs, and yeast infections more common.
- Diabetic stiff hand syndrome: stiffness in hands, limited movement, or a “positive prayer sign” caused by sugar binding to skin and tendon proteins.
- Frozen shoulder and trigger finger: pain and limited movement in the shoulder or fingers, with a snapping sensation when moving inflamed tendons.
- Neuropathy: numbness, tingling, or pain in hands and feet due to nerve and blood vessel damage, often leading to foot deformities like Charcot foot.
- Diabetic foot infections: poor sensation, weakened immune response, and slow healing can result in severe infections and potential amputations.
- Gastroparesis: damage to stomach nerves causes delayed digestion, leading to bloating, nausea, and erratic blood sugar levels.
For more on all of these, plus some visuals of the things like what exactly is a “positive prayer sign”, enjoy:
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Want to learn more?
You might also like to read:
Cost of Insulin by Country 2024 ← after the US, the next most expensive country is Chile, at around 1/5 of the price; the cheapest listed is Turkey, at around 1/33 of the price.
Take care!
Don’t Forget…
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