A digital emergency department avoidance project at Galway University Hospital dramatically reduced the number of patients attending the hospital’s emergency department while also saving bed days.

GUH has reported the findings of a pilot of an acute integrated pre-admission navigational hub, which operated on a restricted basis (Mon-Fri 9am-1pm) for a five-month period. Thirteen GP practices with 48 GPs were involved in the pilot, including one practice located on Inishturk Island.

During the restricted hours, participating GPs referred patients to the virtual hub via Healthlink or phone rather than directly to the ED. Referrals were screened in real time by a clinical case manager and patients were directed to the most appropriate care pathways.

The key goal of the acute navigation hub is to decrease the number of GP-referred ED presentations by 10 per cent.

Over the five-month timeframe, the hub dealt with 108 referrals. Two thirds of these patients were able to avoid an ED visit as a result. Of the 108 referrals, 59 patients were diverted to new or existing pathways. Almost 80 per cent of patients were seen by the appropriate specialist within one week of referral to the virtual hub.

Older patients and those with multiple comorbidities tend to record higher emergency department attendance rates. In 35 patients aged 75 or older who were referred to the navigational hub, 28 (80%) avoided ED attendances as a result. The pilot resulted in an estimated 156 bed days saved over the course of five months.

Consultant cardiologist at GUH and chair of the pilot programme Yvonne Smyth said: “This pilot programme has demonstrated significant success and effectively validated the concept of a virtual navigation hub.

“GPs can ensure that their patients are directed to the most suitable area, either within the Acute Floor, [via] the diverse range of services now available in the community hubs, or rapid access to outpatient care, when appropriate, thereby minimising unnecessary visits to the Emergency Department. We have created a clinically safe service that is sustainable.”

The GUH emergency department has repeatedly faced overcrowding issues this year. According to official figures from the Irish Nurses and Midwifery Organisation’s Trolley Watch, there were 27 patients waiting on trolleys in the department on one day this week (28/08/2024).

John Lally, a Galway GP who took part in the programme added: “This integrated pathway allows us to work together to treat our patients in the setting most appropriate for their needs, within a reasonable timeframe. The successful pilot shows the importance of more pathways such as this.”

GUH hospital manager Chris Kane said the virtual navigational hub was supporting its aim to achieve the goal of ‘right person, right place, right time, first time’ and to direct patients to the appropriate pathways.