A Regional Virtual Acute Care Helpline to Meet Population Health Needs: Data from Singapore’s NUHS Virtual Care Centre

Background: Emergency department (ED) overcrowding in Singapore is exacerbated by an ageing population, rising multi-morbidity, and increasing clinical complexity, all contributing to longer hospital stays and delays in accessing urgent care promptly. Data from the Singapore Civil Defence Force (SCDF), the national emergency medical service, shows a steady increase in medical emergency calls, with most directed to hospital EDs. The COVID-19 pandemic has further emphasised the importance of scalable pre-hospital triage models that can safely manage acute but non-emergency cases within the community. We present findings from the National University Health System (NUHS) Virtual Care Centre (VCC), a clinician-led regional helpline designed to reduce unnecessary ED visits, support continuity of care, and enable access to acute care beyond hospital walls.

 

Approach: The VCC was initially piloted at Alexandra Hospital, a regional hospital within NUHS, in July 2020, as a post-discharge medical helpline. It was gradually expanded to include outpatient and ED attendances, other NUHS institutions, primary care providers, and community partners. The helpline follows a four-tier structured triage protocol. Trained care managers conduct screening.

 

Medical queries are then escalated to nurses and/or specialist physicians for clinical assessment. Depending on their clinical condition, patients are either directed to the nearest ED facility, or NUHS@Home (Hospital at home) or provided a direct admission to a brick-and-mortar hospital or referral to a specialist outpatient clinic or family physician. This allows seamless care transitions between hospital and community teams, ensuring timely access to acute care by the right teams. A retrospective review of call data from 2020 to 2024 analysed service utilisation, case characteristics, outcomes, and safety indicators.

 

Results: From July 2020 to December 2024, VCC managed 4,857 calls, with 59% (n=2,879) relating to medical calls. Call volume increased steadily from 30 per month in 2020 to 200 per month in 2024, reflecting service growth. Patients were generally older, with an average age of 70.5 years, and 55.4% were female. Most medical calls (76.4%) involved acute symptoms or problems with medical devices, such as nasogastric tubes or indwelling catheters. Approximately 63.7% (n=1,834) of calls required escalation and were managed virtually by physicians. Only 13.8% (n=397) required redirecting to the ED, and 3.3% (n=94) were directly admitted to an acute hospital. Notably, 69.1% of patients avoided ED visits within 72 hours post-call. Of those sent to the ED, 37.3% were admitted within that period, indicating appropriate risk assessment. Over-triage was moderate at 39.6%, while under-triage was 4.9% at 72 hours post-call resolution. Importantly, no admissions to High Dependency Units or Intensive Care Units occurred within this timeframe and the 30 days mortality rate was low at 2.3%, highlighting the service's efficacy and safety.

 

Implication; NUHS VCC demonstrates that a regional helpline can address population health needs by diverting lower-acuity cases from EDs, while maintaining safety and ongoing care. It effectively utilises digital technology and a multidisciplinary approach to enable quick triage, connect with community and primary care providers to enable access to timely delivery of acute care, and generate data-driven outcomes.