Health service: Barossa Hills Fleurieu Local Health Network (BHFLHN) 

Facilities: Kapunda Hospital, Tanunda Hospital, Angaston Hospital 

Location: Rural South Australia

The situation

Like most rural health networks, BHFLHN manages a familiar set of pressures: a small, stretched workforce, unpredictable after-hours demand, and distances between patients and specialist care. Kapunda, Tanunda, and Angaston Hospitals each rely on an on-call doctor and their nursing teams to hold the fort overnight.

BHFLHN began working with My Emergency Doctor (MED) to provide virtual emergency medicine support to manage medical workforce fatigue - giving nursing staff at all three sites access to a senior emergency physician (FACEM) by video, day or night.

Since commencing in March, MED supported 306 consultations (till 30 June) across the three sites. A look at that data tells a fairly clear story about how the service has been used, and what difference it's made.

Most patients stayed where they were. 

86.6% of patients were managed on site, and a further 2.6% were admitted locally - meaning close to 9 in 10 patients (89%) were cared for without needing to travel elsewhere, supporting ‘care closer to home’. That held up consistently across all three hospitals: Tanunda (91%), Kapunda (87%) and Angaston (82%) each managed the large majority of presentations locally.

Outcomes at a glance: 

• 306 consults delivered across the three sites in four months, spanning CAT2 (2%) through CAT5 (3%) — the bulk sitting in CAT3 (57%) and CAT4 (38%) 
• 89% of patients treated without a transfer — 86.6% managed in situ plus 2.6% admitted locally
• 74% of consults happen 6pm–8am (after-hours) covering the gap when it matters most
• Under 1 minute average wait for a Patient Support Officer to answer a call
• 18 minutes average wait for FACEM assessmen

The cases that were transferred needed to be. Around 8% of patients were sent on to a larger hospital, to receive the clinical care required -  - conditions like bowel obstruction, sepsis, respiratory failure, and major trauma, where in-person, hospital-level care was genuinely the right next step. 

When it’s needed most: Strengthening, not replacing the local workforce

MED strengthens the local workforce by closing critical coverage gaps while building capability within regional teams across BHFLHN. 

• Reliable overnight and weekend support helps reduce clinician fatigue.
• 24/7 access to a dedicated FACEM gives rural nurses immediate specialist backup when complex decisions arise.
• Clinical confidence and upskilling: real-time peer-to-peer guidance from MED FACEMs improves decision-making, confidence, and learning for regional nurses and clinicians.
• Reduced reliance on locums: dependable senior emergency specialist coverage reduces the need for expensive fly-in fly-out locums, whose training and experience may not match that of MED's FACEMs.

74% of all consults happened between 6pm and 8am 

Nearly three-quarters of all consultations (74%) happened between 6pm and 8am — the hours when these hospitals may not have have a doctor available or at the very least, a doctor on-call. Most presentations were moderate in urgency: 57% were triage category 3 and 38% were category 4, the kind of cases that are hard to staff for overnight but don't need a full emergency team either. Only a small number (2%) were higher-acuity category 2 presentations.

“Remote Emergency Physicians (FACEMs) step in seamlessly to support our regional clinicians when needed. It’s not just a video consult; it’s a robust collaboration that ensures a patient gets immediate access to senior emergency specialist decision-making, right alongside their local care team.” - Associate Professor Dr Sharon Morton, Executive Director Medical Services, BHFLHN

Essential Regional Care Infrastructure

Within the first eight weeks of service delivery, utilisation had nearly doubled the original forecast, with demand continuing to climb as confidence and community awareness grew. 

Recognising the critical need for reinforced medical support, MED and BHFLHN proactively expanded the partnership to include:

• 24/7 ED Support: MED assumed round-the-clock coverage for Angaston Hospital’s Emergency Department from 0800 Tuesday to 0800 Friday weekly.
• Acute Ward Integration: During these same windows, MED extended coverage to support Angaston’s acute inpatient ward, ensuring seamless continuity of care.

The rapid adoption of MED’s services demonstrates the vital role that flexible, senior-led virtual care now plays in regional health networks.

Looking ahead

BHFLHN's experience reflects a challenge many rural and regional health services are navigating at once: fewer available clinicians, rising costs for temporary coverage, and communities spread across long distances. For BHFLHN, virtual emergency medicine has been one part of the response - not a substitute for local staff, but a way to make sure they're not carrying that load alone.

"It provides timely access to senior emergency expertise, strengthens our local clinical teams, and supports safer, more sustainable care for our communities." — Kylie Williams, GAICD, Executive Director Operations, BHFLHN.