What 380,000 virtual consultations taught us
It’s 2:30 am. You’re five hours into your night shift.
The waiting room is still full.
Your next patient is a two-year-old with ear pain.
They’ve already waited as long as you’ve been at work.
Mum apologises for coming.
Dad says their GP couldn’t see them.
The child is happily eating a packet of chips.
Twenty minutes later, they’re heading home with reassurance, analgesia and safety-net advice.
You can’t help wondering whether there was a better way.
Since launching in 2020, the Virtual Emergency Department (VED) has provided more than 380,000 paediatric consultations, making it one of the world’s largest paediatric virtual emergency departments. Our descriptive study (Lawrence et al.) didn’t simply ask whether virtual emergency medicine works -it asked what happens when you redesign access to paediatric emergency expertise.
Lawrence J, Boyd JH, Rosier V, Hutton J, Sher L, Semciw AI, Miller SM, Jessup RL, Talevski J. Implementation of a paediatric virtual emergency department: a descriptive analysis. Journal of Paediatrics and Child Health. 2026 Mar;62(3):381-8.
Four lessons stood out.
Lesson 1 – Families often need expertise more than they need an Emergency Department
Emergency Departments exist for emergencies. Yet every paediatric emergency physician knows that a substantial proportion of children presenting each day don’t require imaging, pathology or admission.
They come because they’re worried.
Their GP has finished.
It’s after dinner.
Their baby is breathing a little faster.
Their toddler has had a fever for twelve hours.
Their six-year-old won’t use an arm after a fall.
The problem isn’t inappropriate attendance. It’s that families have very few ways to access experienced paediatric advice when uncertainty strikes.
That uncertainty drives overcrowded waiting rooms, prolonged waits and increasing pressure on already stretched emergency departments. Children spend hours in busy waiting rooms where they’re exposed to every respiratory virus circulating that week, only to leave with reassurance and advice.
Virtual emergency medicine offers another option.
Instead of asking parents to decide whether they should take their child to hospital, we ask an experienced paediatrician to make that decision with them.
Since launch, VED has seen more than 380,000 paediatric presentations, averaging around 350 children each day, rising to 500 during winter. Nearly two-thirds occur outside business hours, and almost three-quarters are self-referrals – demonstrating both demand and trust in virtual emergency care.
The service also integrates with Ambulance Victoria, Nurse-on-Call and the Maternal Child Health line, ensuring children can access paediatric expertise regardless of how they enter the healthcare system.
Bubble: The goal isn’t to keep children away from hospital. It’s to make sure the children who need hospital get there, while everyone else receives the right care in the right place.
Lesson 2 – Video is better than you think
Most virtual consultations involve conditions every emergency clinician sees repeatedly:
- Fever
- Bronchiolitis and viral wheeze
- URTIs
- Vomiting and diarrhoea
- Viral exanthems
- Minor injuries
These are diagnoses built on history, observation and trajectory rather than investigations.
Interestingly, video sometimes provides clinicians with information they would otherwise never obtain in an Emergency Department.
Children who become silent and cling to their parents in a consultation cubicle often behave completely differently at home. They negotiate for snacks, climb furniture, argue with siblings and demonstrate just how well – or unwell – they really are. We see bedrooms, lounge rooms, medication cupboards and support networks. Context matters.
Of course, video cannot replace a physical examination. But it often replaces something equally important – the artificial behaviour created by an unfamiliar clinical environment.
Bubble: Sometimes the best place to assess a child is where they are behaving most like themselves.
Lesson 3 – Virtual care is an exercise in risk stratification, not diagnosis
The obvious criticism of virtual emergency medicine is also the correct one.
There is no abdominal examination.|
No auscultation.
No observations.
No opportunity to notice subtle cues while walking past the bed.
Virtual emergency medicine doesn’t eliminate uncertainty – it changes it.
Rather than asking “What is the diagnosis?” clinicians often begin by asking:
“Will this child gain anything from a physical examination or intervention today?”
If the answer is yes, the child needs to be seen.
If not, the safest place may be home, supported by clear follow-up and robust safety-netting.
Clinical reasoning therefore shifts from diagnosis towards risk stratification.
Experienced clinicians continuously weigh pre-test probability, illness trajectory, parental concern and the likelihood that an in-person assessment would alter management.
After more than 380,000 consultations, around 88% of children have been safely managed without attending a physical Emergency Department. That statistic doesn’t reflect technology. It reflects clinical judgement.
Bubble: Technology doesn’t replace clinical judgement. It changes how we apply it.
Lesson 4 – The biggest impact isn’t convenience – it’s preserving emergency care for the children who need it most
The most obvious benefit of virtual emergency medicine is convenience.
Families stay home.
Children sleep in their own beds.
Parents avoid hours in waiting rooms.
Siblings don’t need babysitters.
But an equal winner is the healthcare system.
Every child safely managed virtually represents one less patient competing for cubicles, nursing time and clinician attention. Every child redirected to primary care represents a better match between need and service. Every ambulance avoided has the potential to remain available for the next genuinely time-critical emergency.
Virtual emergency departments aren’t replacing Emergency Departments. They’re helping Emergency Departments function as they were originally intended.
Bubble: The best Emergency Department visit is often the one that never needed to happen.
So where next?
Virtual emergency medicine won’t replace hospitals. Nor should it. Children will always need procedures, imaging, observation and admission.
The more interesting question is whether we should continue asking families to answer the hardest question in paediatrics alone: “Does my child need hospital?” Perhaps that question is better answered by a paediatric emergency clinician before the journey begins.
If emergency demand continues to outstrip capacity, rather than keep building larger and larger waiting rooms, maybe we need to ensure that fewer children have to sit in them.
If you are interested in finding out more, or even working in a Virtual ED from the comfort of your own home, then reach out to Jo Lawrence or Jason Nebbs for more information.
