{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T01:22:02Z","timestamp":1792027322400,"version":"4.4.0"},"reference-count":38,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Form Res"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Emergency department (ED) overcrowding and delayed access to care are ongoing challenges in Singapore. The COVID-19 pandemic further underscored the need for scalable virtual care models that go beyond traditional hospital settings, allowing patients to access acute specialist care quickly and efficiently.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study describes the design, implementation, and early outcomes of the National University Health System (NUHS) Virtual Care Centre (VCC), a clinician-led helpline aimed at reducing unnecessary ED visits and supporting community-based acute care.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n In 2020, the NUHS launched the VCC, a helpline at Alexandra Hospital, as a prehospital triage model. The helpline functions as a nurse-led telephone triage with real-time escalation to doctors for urgent medical issues. It ensures the continuity of care for patients recently discharged and diverts nonemergency cases from the ED. A retrospective analysis of call data from 2020 to 2024 was conducted to evaluate utilization patterns, clinical outcomes, and safety.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Over 4 years, the VCC managed 4857 calls, of which 59.3% (n=2879) were clinical in nature. Nearly two-thirds (1834\/2879, 63.7%) were resolved remotely, preventing in-person ED visits. Only 13.8% (397\/2879) required redirection to an ED, and 3.3% (95\/2879) were directly admitted to an acute hospital or hospital at home service. Within 72 hours of call resolution, 69.1% (1990\/2879) of the callers avoided an ED visit. Undertriage was 4.9% (110\/2232) at 72 hours post call resolution, with no high dependency or intensive care unit admissions during this period. Mortality rates were low (1.0% at 14 days; 2.3% at 30 days).<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The NUHS VCC provides a feasible and safe model for virtual acute care triage within the public health care system. It effectively diverted lower-acuity cases from the ED and ensured continuity of care, offering a scalable approach aligned with national efforts to extend health care beyond hospital walls.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/86556","type":"journal-article","created":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T14:20:07Z","timestamp":1773066007000},"page":"e86556-e86556","source":"Crossref","is-referenced-by-count":1,"title":["Regional Virtual Acute Care Helpline in Singapore at a National University Health System Virtual Care Centre: Retrospective Study"],"prefix":"10.2196","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-7885-6297","authenticated-orcid":false,"given":"Linda","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1494-9327","authenticated-orcid":false,"given":"Soon Hoe","family":"Ho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8880-004X","authenticated-orcid":false,"given":"Mei Fong","family":"Liew","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6300-7515","authenticated-orcid":false,"given":"Serene Xin Lin","family":"Wong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9747-5277","authenticated-orcid":false,"given":"Amartya","family":"Mukhopadhyay","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2378-1957","authenticated-orcid":false,"given":"Rachel Hui","family":"Choe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6466-0823","authenticated-orcid":false,"given":"Priyanka","family":"Khatri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4921-1864","authenticated-orcid":false,"given":"Nastar","family":"Ashna","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2240-6904","authenticated-orcid":false,"given":"Jonathan Edward","family":"Jacob","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-3496-9369","authenticated-orcid":false,"given":"Tze Chin","family":"Wong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-7690-0127","authenticated-orcid":false,"given":"Teresa","family":"Koh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-5811-737X","authenticated-orcid":false,"given":"Lipin","family":"Tan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-1340-3976","authenticated-orcid":false,"given":"Si Hui","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6590-0913","authenticated-orcid":false,"given":"Wern Lunn","family":"Kueh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-3700-8376","authenticated-orcid":false,"given":"Erna Gondo","family":"Santoso","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-6157-6681","authenticated-orcid":false,"given":"Shikha","family":"Kumari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-6708-3440","authenticated-orcid":false,"given":"Satya Pavan Kumar","family":"Gollamudi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,5,13]]},"reference":[{"issue":"1","key":"R1","doi-asserted-by":"publisher","DOI":"10.1186\/1741-7015-11-258","article-title":"Who uses emergency departments inappropriately and when\u2014a national cross-sectional study using a monitoring data system","volume":"11","author":"McHale","journal-title":"BMC Med"},{"issue":"1","key":"R2","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1590\/s0102-311x2009000100002","article-title":"Inappropriate use of emergency services: a systematic review of prevalence and associated factors","volume":"25","author":"Carret","journal-title":"Cad Saude Publica"},{"key":"R3","doi-asserted-by":"publisher","DOI":"10.2147\/IJGM.S391126","article-title":"Analysis of emergency department use by non-urgent patients and their visit characteristics at an academic center","volume":"16","author":"Alnasser","journal-title":"Int J Gen Med"},{"issue":"6","key":"R4","doi-asserted-by":"publisher","first-page":"605","DOI":"10.1016\/j.annemergmed.2012.10.026","article-title":"Effect of emergency department crowding on outcomes of admitted patients","volume":"61","author":"Sun","journal-title":"Ann Emerg Med"},{"issue":"2","key":"R5","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1111\/jnu.12055","article-title":"The relationship between emergency department crowding and patient outcomes: a systematic review","volume":"46","author":"Carter","journal-title":"J Nurs Scholarsh"},{"issue":"2","key":"R6","doi-asserted-by":"publisher","first-page":"126","DOI":"10.1016\/j.annemergmed.2008.03.014","article-title":"Systematic review of emergency department crowding: causes, effects, and solutions","volume":"52","author":"Hoot","journal-title":"Ann Emerg Med"},{"issue":"3","key":"R7","doi-asserted-by":"publisher","first-page":"170","DOI":"10.47102\/annals-acadmedsg.2021437","article-title":"Determinants of emergency department utilisation by older adults in Singapore: a systematic review","volume":"51","author":"Tang","journal-title":"Ann Acad Med Singap"},{"key":"R8","doi-asserted-by":"publisher","DOI":"10.1177\/2050312116671953","article-title":"Emergency department crowding in Singapore: insights from a systems thinking approach","volume":"4","author":"Schoenenberger","journal-title":"SAGE Open Med"},{"issue":"8","key":"R9","doi-asserted-by":"publisher","first-page":"483","DOI":"10.47102\/annals-acadmedsg.2021483","article-title":"Nationwide study of the characteristics of frequent attenders with multiple emergency department attendance patterns","volume":"51","author":"Pek","journal-title":"Ann Acad Med Singap"},{"issue":"9","key":"R10","doi-asserted-by":"publisher","first-page":"1025","DOI":"10.1111\/acem.12738","article-title":"Factors contributing to inappropriate visits of frequent attenders and their economic effects at an emergency department in Singapore","volume":"22","author":"Boh","journal-title":"Acad Emerg Med"},{"key":"R11","unstructured":"Beds occupancy rate (BOR). Ministry of Health, Singapore. Apr 25, 2026. URL: https:\/\/www.moh.gov.sg\/others\/resources-and-statistics\/healthcare-institution-statistics-beds-occupancy-rate-(bor)\/ [Accessed 16-04-2026]"},{"key":"R12","unstructured":"Annual report 2022\/23. Singapore Civil Defence Force; 2023. URL: https:\/\/www.scdf.gov.sg\/docs\/default-source\/media-room-(publications)\/annual-reports\/annual-report-22-23_compressed.pdf?sfvrsn=8cdb1155_1 [Accessed 04-04-2026]"},{"key":"R13","unstructured":"Waiting time for admission to ward. Ministry of Health (MOH) Singapore. URL: https:\/\/www.moh.gov.sg\/others\/resources-and-statistics\/healthcare-institution-statistics-waiting-time-for-admission-to-ward\/ [Accessed 07-04-2025]"},{"issue":"23","key":"R14","doi-asserted-by":"publisher","first-page":"699","DOI":"10.15585\/mmwr.mm6923e1","article-title":"Impact of the COVID-19 pandemic on emergency department visits\u2014United States, January 1, 2019-May 30, 2020","volume":"69","author":"Hartnett","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"R15","doi-asserted-by":"publisher","DOI":"10.1016\/j.ceh.2023.12.002","article-title":"Post pandemic analysis on comprehensive utilization of telehealth and telemedicine","volume":"7","author":"Ndwabe","journal-title":"Clinical eHealth"},{"issue":"12","key":"R16","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.75505","article-title":"The role of telemedicine in emergency department triage and patient care: a systematic review","volume":"16","author":"Ahmed","journal-title":"Cureus"},{"key":"R17","doi-asserted-by":"publisher","DOI":"10.2196\/42840","article-title":"Using virtual emergency medicine clinicians as a health system entry point (virtual first): cross-sectional survey study","volume":"25","author":"Potter","journal-title":"J Med Internet Res"},{"issue":"1","key":"R18","doi-asserted-by":"publisher","DOI":"10.1186\/s12245-022-00442-4","article-title":"Impact of integrating out-of-hours services into Emergency Medical Services Copenhagen: a descriptive study of transformational years","volume":"15","author":"Zinger","journal-title":"Int J Emerg Med"},{"issue":"4","key":"R19","doi-asserted-by":"publisher","DOI":"10.1002\/emp2.13231","article-title":"From concept to reality: a comprehensive exploration into the development and evolution of a virtual emergency department","volume":"5","author":"Talevski","journal-title":"J Am Coll Emerg Physicians Open"},{"issue":"1","key":"R20","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1111\/1742-6723.14328","article-title":"Implementing a virtual emergency department to avoid unnecessary emergency department presentations","volume":"36","author":"Kelly","journal-title":"Emerg Med Australas"},{"issue":"9","key":"R21","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0285468","article-title":"\u201cIt saved me from the emergency department\u201d: a qualitative study of patient experience of virtual urgent care in Ontario","volume":"18","author":"Dainty","journal-title":"PLoS ONE"},{"key":"R22","doi-asserted-by":"publisher","DOI":"10.2196\/49786","article-title":"The implementation of a virtual emergency department: multimethods study guided by the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework","volume":"7","author":"Shuldiner","journal-title":"JMIR Form Res"},{"issue":"8","key":"R23","doi-asserted-by":"publisher","DOI":"10.1056\/CAT.22.0422","article-title":"Leveraging telemedicine to reduce ED overcrowding: the Quir\u00f3nsalud Virtual Urgent Care Program","volume":"4","author":"Short Apellaniz","journal-title":"NEJM Catal Innov Care Deliv"},{"issue":"11","key":"R24","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2013-003451","article-title":"Impact of the urgent care telephone service NHS 111 pilot sites: a controlled before and after study","volume":"3","author":"Turner","journal-title":"BMJ Open"},{"issue":"1","key":"R25","doi-asserted-by":"publisher","DOI":"10.1038\/s41746-025-01590-6","article-title":"Virtual urgent care in an integrated value based healthcare system","volume":"8","author":"Nguyen","journal-title":"NPJ Digit Med"},{"key":"R26","unstructured":"About our regional health system. National University Health System. URL: https:\/\/www.nuhs.edu.sg\/care-in-the-community\/about-our-regional-health-system [Accessed 16-04-2026]"},{"issue":"7","key":"R27","doi-asserted-by":"publisher","first-page":"392","DOI":"10.47102\/annals-acadmedsg.2021465","article-title":"Treating acutely ill patients at home: data from Singapore","volume":"51","author":"Ko","journal-title":"Ann Acad Med Singap"},{"key":"R28","doi-asserted-by":"publisher","DOI":"10.3389\/frhs.2025.1571090","article-title":"Barriers and facilitators to scale-up of hospital-at-home: an observational cohort study protocol","volume":"5","author":"Ko","journal-title":"Front Health Serv"},{"issue":"9","key":"R29","doi-asserted-by":"publisher","first-page":"105154","DOI":"10.1016\/j.jamda.2024.105154","article-title":"Home-first or hospital-first? A propensity score-weighted retrospective cohort study","volume":"25","author":"Ko","journal-title":"J Am Med Dir Assoc"},{"key":"R30","unstructured":"Visiting the emergency medicine department. National University Hospital. 2025. URL: http:\/\/www.nuh.com.sg\/care-at-nuh\/specialties\/emergency-medicine\/visit-the-emergency-department [Accessed 04-04-2026]"},{"key":"R31","unstructured":"Emergency medical services. SCDF. 2017. URL: http:\/\/www.scdf.gov.sg\/home\/about-scdf\/emergency-medical-services [Accessed 04-04-2026]"},{"key":"R32","unstructured":"Division of Advanced Internal Medicine. National University Hospital. 2024. URL: https:\/\/www.nuh.com.sg\/care-at-nuh\/specialties\/medicine\/division-of-advanced-internal-medicine [Accessed 04-04-2026]"},{"issue":"4","key":"R33","doi-asserted-by":"publisher","first-page":"553","DOI":"10.1111\/1742-6723.14157","article-title":"Disposition of patients utilising the virtual emergency department service in southeast region of Melbourne (SERVED-1)","volume":"35","author":"Sri-Ganeshan","journal-title":"Emerg Med Australas"},{"issue":"6","key":"R34","doi-asserted-by":"publisher","DOI":"10.1093\/haschl\/qxad079","article-title":"Medical advice lines offering on-demand access to providers reduced emergency department visits","volume":"1","author":"Tran","journal-title":"Health Aff Sch"},{"issue":"43","key":"R35","doi-asserted-by":"publisher","first-page":"E1463","DOI":"10.1503\/cmaj.230492","article-title":"Health care utilization and outcomes of patients seen by virtual urgent care versus in-person emergency department care","volume":"195","author":"McLeod","journal-title":"CMAJ"},{"issue":"1","key":"R36","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1080\/02813432.2017.1288816","article-title":"The use of a Swedish telephone medical advice service by the elderly\u2014a population-based study","volume":"35","author":"Dahlgren","journal-title":"Scand J Prim Health Care"},{"issue":"5","key":"R37","doi-asserted-by":"publisher","first-page":"15","DOI":"10.55729\/2000-9666.1237","article-title":"Day of the week variation in emergency department arrivals, chest pain, and acute myocardial infarction throughout 2016-2019","volume":"13","author":"Ebrahimihoor","journal-title":"J Community Hosp Intern Med Perspect"},{"issue":"10","key":"R38","doi-asserted-by":"publisher","first-page":"2563","DOI":"10.1287\/mnsc.2014.1901","article-title":"The fresh start effect: temporal landmarks motivate aspirational behavior","volume":"60","author":"Dai","journal-title":"Manage Sci"}],"container-title":["JMIR Formative Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/formative.jmir.org\/2026\/1\/e86556","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T17:14:23Z","timestamp":1782839663000},"score":1,"resource":{"primary":{"URL":"https:\/\/formative.jmir.org\/2026\/1\/e86556"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,13]]},"references-count":38,"URL":"https:\/\/doi.org\/10.2196\/86556","relation":{},"ISSN":["2561-326X"],"issn-type":[{"value":"2561-326X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,13]]},"article-number":"v10i1e86556"}}