As the burden of disease and mortality rate increases with increasing remoteness from metropolitan centres, there is a need not only for effective primary health care (PHC) services, but also for effective emergency services which give remote residents access to timely, high quality emergency life-saving care.
In February 2018, a dedicated Medical Retrieval and Consultation Centre (MRaCC) was launched, to provide a medical retrieval service for acute care cases, inter-hospital transfers and repatriation of patients back to country. MRaCC was designed to better streamline communication processes during emergency retrievals; to bring the current system into line with national developments in Retrieval Medicine practice; and to enhance the quality of the retrieval service and decrease risk to acutely sick patients.
MRaCC provides a 24-hour, single-point-of-contact emergency consultation service for all clinicians and for sick patients. It operates in parallel with a PHC Remote Medical Practitioner (RMP) service operating during normal office hours, which provides a consultation service for non-emergency primary care conditions.
The aim of this study is to evaluate the timeliness, efficiency and impact of MRaCC. Specific objectives of the study:
- To assess changes in the timeliness of specialist emergency advice and retrieval.
- To assess the impact of MRaCC on remote clinicians and efficiency for remote clinicians.
- To assess changes in efficiency for ED FACEMs.
- To assess changes in outcomes for patients.
- To quantify the cost and cost-effectiveness of the MRaCC model compared to the previous RMP-led model.
We found that under the new system there were fewer retrievals and significantly lower mortality. Results of the study indicate that changing to the new model was highly cost-effective.
We recommend other remote regions in Australia and internationally that have GP-led retrieval services to strongly consider the benefits of transitioning to a system which separates emergency and primary care referrals with each type of referral being directed to the health professional with the most appropriate skills for managing the presenting problem.
- Prof John Wakerman, Menzies School of Health Research
- Dr Deb Russell, Menzies School of Health Research
- Dr Richard Johnson, Central Australia Health Service
- Dr Petra Niclasen, Central Australia Health Service
- Dr Bridgit Honan, Central Australia Health Service
- Dr Yuejen Zhao, Department of Health
- Dr Michelle Fitts, Menzies School of Health Research
- Ms Zania Liddle, Menzies School of Health Research
- Dr Supriya Mathew, Menzies School of Health Research