In November 2024, Cork University Hospital launched the Urgent Virtual Care Centre, an integrated, senior clinician-led telemedicine service designed to provide real-time clinical support, system integration, assessment, and in many cases definitive care for patients with urgent presentations. The service operates five days per week, Monday to Friday, from 09:00 to 17:00, and accepts referrals from general practitioners, paramedics and advanced paramedics of the National Ambulance Service, and selected urgent care providers. Rather than replacing existing pathways, the centre sits alongside them as a virtual front door: a referring clinician contacts the service, and the patient is reviewed remotely by a consultant in emergency medicine or acute medicine. The consultant then works in consultation with the referring general practitioner to determine the most appropriate disposition, which may include follow-up in general practice, direct access to community diagnostics, outpatient referral, or hospital attendance when required.

The design principle is deceptively simple but operationally demanding. By placing a senior decision-maker at the point of referral, the service aims to convert what would traditionally have been an ambulance transfer or a directed emergency department attendance into a more nuanced triage conversation. A general practitioner worried about an older patient with abdominal pain can discuss the case directly with an emergency medicine consultant within minutes, and together they can decide whether the patient needs hospital imaging, a community-based X-ray, a home visit from a community intervention team, or simply reassurance and scheduled review. The same logic applies to ambulance crews, who can avoid transporting patients to a crowded emergency department when a virtual consultation indicates a better-fitting alternative pathway.

To assess whether the model worked in practice, the research team conducted a prospective evaluation over the service’s first six months, from November 2024 to April 2025, using descriptive analysis of patient demographics, referral sources, presenting complaints, and outcomes. The study, published in BMC Health Services Research, was conducted as a service evaluation under Cork University Hospital governance and quality assurance arrangements, using anonymised, routinely collected service data, and was registered with the hospital’s research office and quality and patient safety department in accordance with local governance requirements. The evaluation was carried out in accordance with the principles of the Declaration of Helsinki, and the study received no external funding.

The headline numbers are striking. Over the six-month period, 2,584 patients were assessed through the virtual service. The overwhelming majority of referrals, 2,446 patients or 94.7 percent, originated from general practice, confirming that family doctors were the primary users of the new pathway and saw it as a viable alternative to sending patients to the emergency department. Notably, patients aged over 70 constituted 35.6 percent of all assessments, or 920 individuals, indicating that the service was heavily used for older adults, the very group most likely to experience poor outcomes from unnecessary emergency department attendance and hospital admission.

The spectrum of presenting complaints reflected the bread-and-butter of unscheduled care. Lower limb pain was the most common reason for referral, accounting for 154 cases or 6 percent of assessments, followed closely by abdominal pain with 149 cases at 5.8 percent, back pain with 144 cases at 5.6 percent, chest pain with 136 cases at 5.3 percent, and shortness of breath with 131 cases at 5.1 percent. This mix is clinically significant because it includes presentations that range from the essentially benign to the immediately life-threatening. Chest pain and shortness of breath, in particular, demand careful discrimination between conditions such as acute coronary syndromes, pulmonary embolism, and pneumonia on one hand, and musculoskeletal or anxiety-related causes on the other. The fact that a virtual, consultant-led service was trusted with such presentations suggests a deliberate strategy of using senior clinical judgement to make remote triage safe.

The outcomes data provide the core evidence for the model’s potential. Overall, 1,888 patients, representing 73.1 percent of all assessments, were managed without requiring immediate physical attendance at the emergency department. The final dispositions were diverse: 568 patients, or 22 percent, were discharged to the care of their general practitioner; 338 patients, or 13.1 percent, received direct access to diagnostics without passing through the emergency department; 279 patients, or 10.8 percent, were referred to outpatient services; 302 patients, or 11.7 percent, were discharged home; and 196 patients, or 7.6 percent, were discharged to other hospitals. Smaller numbers were directed to community-based services, including the Alternative Prehospital Pathway car, the Integrated Care Programme for Older People, Pathfinder, and mobile X-ray, which together accounted for 129 patients or 5.0 percent. Fourteen patients, or 0.5 percent, were discharged to nursing homes, 49 patients, or 1.9 percent, were given scheduled hospital attendances, and 13 patients, or 0.5 percent, were not seen by a doctor.

The remaining 696 patients, or 26.9 percent, did require emergency department attendance, and the reasons why are as informative as the numbers who avoided it. Among those who needed immediate hospital care, the most frequent diagnoses were chest pain, accounting for 42 cases, stroke, accounting for 21 cases, and headache, accounting for 18 cases. This pattern is exactly what one would hope to see from a safety-oriented triage system: the conditions most likely to benefit from rapid, in-person hospital assessment, such as suspected cardiac events and cerebrovascular accidents, were correctly identified and routed to the emergency department, while a large majority of less acute presentations were redirected to appropriate lower-acuity settings. Critically, the evaluation reported no adverse events, an essential early signal for any service that seeks to manage urgent presentations remotely.

The technical architecture of the model deserves attention because it illustrates how telemedicine in urgent care differs from routine remote consultations. The service functions not as a standalone virtual clinic but as an integration layer connecting hospital, general practice, and community services. The consultant conducting the virtual review has the authority and the systems access to arrange direct community diagnostics, activate community intervention teams, mobilise mobile imaging, or schedule hospital attendance, meaning that the virtual consultation translates immediately into a concrete care pathway. This integration is what allows the service to offer definitive care rather than merely deferring decisions. It also aligns closely with the objectives of Sláintecare, Ireland’s programme for health service reform, which aims to deliver the right care in the right place at the right time by shifting appropriate care out of acute hospitals and into communities.

The authors of the evaluation, a large multidisciplinary team spanning Cork University Hospital, University College Cork, the National Ambulance Service, the Health Service Executive South West Regional Health Area, and the Irish College of General Practitioners, are careful to frame these findings as an initial experience rather than a definitive verdict. The study is descriptive, and questions about long-term safety, cost-effectiveness, patient experience, and effects on emergency department crowding will require further evaluation. Nevertheless, the early numbers suggest that a consultant-led virtual triage service embedded within an integrated care network can safely divert roughly three-quarters of referred patients away from immediate emergency department attendance, while reliably capturing the minority who need urgent hospital care. As health systems across the world grapple with ageing populations and rising demand for unscheduled care, the Cork experience offers a compelling proof of concept that the emergency department of the future may begin not at the hospital door, but in a conversation between clinicians connected by a screen.

Subject of Research: Evaluation of a consultant-led urgent virtual telemedicine triage service for unscheduled care at Cork University Hospital

Article Title: Reimagining unscheduled care; initial evaluation of an urgent virtual care model at Cork University Hospital

Article References: Reimagining unscheduled care; initial evaluation of an urgent virtual care model at Cork University Hospital. (n.d.). https://doi.org/10.1186/s12913-026-15391-4

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15391-4

Keywords: urgent virtual care, telemedicine, emergency medicine, unscheduled care, emergency department, integrated care, health service delivery, Ireland, Sláintecare, geriatric care, general practice, triage