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

Abstract Background General Practice and Emergency Departments (EDs) across Ireland are experiencing sustained and escalating demand. This trend reflects broader demographic and structural pressures, including population ageing, increasing multimorbidity, and a growing cohort of patients with complex care needs, compounded by access challenges to primary care, urgent community diagnostics, and outpatient services. In response, Cork University Hospital (CUH) established the Urgent Virtual Care (UVC) Centre in November 2024 - an integrated, senior clinician-led telemedicine service aimed at providing real-time clinical support, system integration, assessment, and/or definitive care for patients with urgent presentations. Methods The UVC in CUH operates five days per week (Monday to Friday, 09:00–17:00), accepting referrals from General Practitioners, National Ambulance Service Paramedics and Advanced Paramedics, and selected urgent care providers. Patients are reviewed virtually by consultants in emergency or acute medicine, who in consultation with the GP, determine appropriate disposition including GP follow-up, direct access to community diagnostics, outpatient referral, or hospital attendance. A prospective evaluation was conducted over the service’s first six months (November 2024 – April 2025), with descriptive analysis of demographics, referral sources, presenting complaints, and outcomes. Results A total of 2,584 patients were assessed. The majority of referrals to the UVC originated from General Practice ( n = 2446, 94.7%). Patients aged over 70 constituted 35.6% ( n = 920) of all assessments. Common presenting complaints included lower limb pain ( n = 154, 6%), abdominal pain ( n = 149, 5.8%), back pain ( n = 144, 5.6%), chest pain ( n = 136, 5.3%) and shortness of breath ( n = 131, 5.1%). Overall, 1,888 patients (73.1%) were managed without requiring immediate physical ED attendance. Final dispositions were discharge to GP care ( n = 568, 22%), direct access to diagnostics ( n = 338, 13.1%), outpatient referral ( n = 279, 10.8%), discharge home ( n = 302, 11.7%), discharge to other hospital ( n = 196, 7.6%), scheduled hospital attendance ( n = 49, 1.9%), community-based services including the Alternative Prehospital Pathway (APP) car, Integrated Care Programme for Older People (ICPOP), Pathfinder or mobile X-ray ( n = 129, 5.0% combined), discharge to nursing home ( n = 14, 0.5%) and not seen by a doctor ( n = 13, 0.5%). A total of 696 patients (26.9%) required ED attendance. The most frequent diagnoses among these patients were chest pain ( n = 42), stroke ( n = 21), and headache ( n = 18). No adverse events were reported. Conclusions The UVC Centre at Cork University Hospital provided a virtual, consultant-led pathway integrating hospital, general practice, and community services. This early experience illustrates how such a model may contribute to Sláintecare’s aim of delivering the right care in the right place.