DIZZEE-TC: DIZZiness Emergency Evaluation Telehealth Clinic

Telehealth for GPs, residential aged care facilities and rural health services requiring specialist evaluation of emergent dizziness/vertigo that would otherwise present to the emergency department (due to reduced confidence of local medical officer/health care provider in conducting vestibular assessments).

Service Model Summary 

An unprecedented initiative to triage dizziness in the community, before the patient presents to the Emergency Department. Triage completed by Advanced Vestibular Physiotherapist with review by ENT medical practitioner to aid in decision of best care pathway. 

DIZEE-TC pilot service will run 5 days per week within standard business hours with view to progress to 7 day service if demand established. Access will be via a landline (example phone number: 13 DIZZEE) where a teleconference will be set up within 10-15 minutes. 

DIZEE-TC recommendations may include (ranging from non-emergency to emergency scenarios): 

1. Immediate action: Guidance through on-the spot assessment and treatment (for example: BPPV treatment)

2. Watch & wait: follow-up home based telehealth appointment 

3. Urgent pathway to acute outpatient clinics for further testing

4. Recommend Emergency Department presentation with DIZZEE-TC providing handover to ED staff prior to arrival. 

 

Funding:

1. Medicare billing using MBS Telehealth codes when ENT Medical Practitioner involved. Using existing ENT staffing (brief step out of usual outpatient clinic)

2. If Vestibular Physiotherapist only consultation: generation of standard Queensland Weighted Activity Units (QWUA) for telehealth occasion of service

 

Why the contribution is important

It has been estimated that total US national costs for people with dizziness presenting to the Emergency Department (ED) exceeds $4 billion per year. Therefore, dizziness reportedly accounts for approximately 4% of chief complaints in the ED. Vestibular disorders are one of the common causes of dizziness. Vestibular disorders are non-life threatening, however, it can be difficult for the generalist clinician to know when it is an inner ear cause rather than something more sinister. For this reason, when a patient with dizziness/vertigo presents to their General Practitioner, a patient may be advised to present to the ED for evaluation. As a vestibular physiotherapist who works in ENT Outpatients and at times involved in evaluating patients in the ED, I have witnessed first hand when an ED presention could have been avoided with timely evalutation at point of GP presentation. DIZZEE-TC would serve to bridge the gap between general practitioner and specialist evaluation of emergent dizziness. 

Secondely, in situations where dizziness has been determined to be vestibular in origin, the GP has still recommended ED presentation or ENT OPD appointment to recieve more specialised guidance of treatment options. DIZZEE-TC would also include ENT recommendations to local medical officer, which in turn would lessen the need to refer to surgical waitlists. 

Thirdly, DIZZEE-TC would also serve as a statewide Queensland Health resource, for rural and remote health services who do not have regular visiting specialists who are trained in the area of differentially diagnosing causes of dizziness. An on the spot telehealth evaluation in the ED in a rural or remote setting may lead to reduced hospital admissions for inner ear conditions. 

Summary

DIZZEE-TC has the potential to reduce dizziness presentations to Metro South Health Emergency Departments, empower local medical officers to differentially diagnose acute causes of dizziness and lessen the state-wide public health costs related to unnecessary vestibular admissions in more rural and remote service areas. 

by LeiaBarnes on August 22, 2019 at 11:18PM

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