How a COVID hotline could help hospitals and GPs

As COVID-19 continues to spread, emergency services are being pushed to their limits.
 
Currently, isolated COVID-positive patients being treated in the home often have little recourse when their condition deteriorates other than to call triple-zero.
 
The situation has reportedly intensified to the point where a record number of triple-zero calls were made in Victoria this week, resulting in significant wait times. On Monday alone, 3250 calls were made – up from around 2000 the same time last year – 40% of which were not life-threatening situations.
 
But a 24/7 COVID hotline, being proposed by a group of GPs, is aiming to ease the burden.
 
Staffed by healthcare workers, people who are confirmed to have COVID or suspect they do, would be able to call direct and be triaged to either receive support through their own general practice, if available, or through the hotline directly.
 
Melbourne GP Dr Nathan Pinskier, who is among the doctors behind the concept, says it would operate as a hospital in the home virtual support service. 
 
‘We’re seeing people who are becoming very sick, very quickly at home – and we’re seeing people now dying at home,’ he told newsGP.
 
‘Or they’re anxious and concerned and they want to talk to someone. So they end up calling triple-zero and … then end up in a long queue in a hospital, when they could have been potentially managed in a different way.’
 
Through the hotline, patients would be offered advice and support. If their condition escalates, but an ambulance is not required, a hospital in the home type model could be enacted, with healthcare workers going direct to the patient, supplying them with digital technology to be able to continue monitoring.
 
If the patient needs more acute monitoring, but is not at the stage of requiring hospitalisation, Dr Pinskier says medi-hotels could also be used as an interim step up.
 
‘It could be underpinned by a flying squad of dedicated providers who go out and see individuals who have been identified either through triage or through various red flags that come up in the clinical software,’ he said.
 
‘So you take the stress off the community providers, you take the stress off the ambulances, and you take the stress off the hospitals.’
 
Meanwhile, a key feature of the service would be continuity of care, ensuring clinical handover, with the patient’s regular GP kept in the loop from the first phone call.
 
Dr Pinskier said it was a year ago that he first raised the issue of GPs not being notified about patients testing positive to COVID-19 with authorities, and that communication issues persist.
 
‘We see this as a major deficit,’ he said. ‘So it’s about joining up the dots effectively.
 
‘This could be done through secure messaging, through uploading information to My Health Record, or a number of other platforms.’
 
As it stands, there is no statewide approach in Victoria, nor a national approach, to who people should call for medical advice if their GP is unavailable or after-hours. While the Victorian Government does run the COVID-19 Positive Care Pathways program, most services operate until 5 pm.
 
‘So we’ve got two-thirds of the week where general practice isn’t open, and even in that one-third when it is open, it’s fairly heavily committed already,’ Dr Pinskier said.
 
‘The obvious number that everyone remembers is triple-zero, so we need to set up an alternative [as a] dedicated COVID clinical support service.
 
‘Otherwise ambulances are going to get swamped as the numbers go up and they won’t cope, hospitals won’t cope, and we’re already hitting the tipping point now.’
 
With Victoria having recorded 1438 locally acquired cases on Thursday, Dr Pinskier says planning for a surge in case numbers should have started months ago.
 
‘I think many of us – and I’ll include myself in this – have been living in a bit of a paradise; perhaps a fool’s paradise,’ he said.
 
‘We thought it would all get managed and go away, and it hasn’t. So we need to be actively preparing.
 
‘But we can’t expect general practice just to cope on the basis of Medicare rebates and sometimes constrained infrastructure. It needs agreement with the key stakeholders around a national approach that will support healthcare providers and patients in a much more effective manner.
 
‘We have a lot of the tools; we’ve now got to enable some of them very quickly.’
 
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