Telemedicine Trends in the ER: Innovative Applications

Emergency Department (ED) traffic continues to be a thorn in the side of healthcare organizations that are under immense pressure from payer organizations to reduce utilization rates and wait times. In 2017, the top five hospitals in terms of ED visits saw nearly 7 million patients walk through their doors, including 210,020 at the busiest facility alone. Overall, the Centers for Disease Control and Prevention (CDC) reports annual ED visits nationwide of 136.9 million, just 12.3 million (9%) of which resulted in hospital admissions and 1.5 million in admissions to a critical care unit.

To shorten the door-to-disposition time without impacting diagnostic accuracy, many hospitals rely on telemedicine for triage and to provide access to specialists and other experts that would otherwise be inaccessible to their patients. And it’s working. In one recent study, researchers found that telemedicine intake did not result in higher or lower utilization of diagnostic testing or interventions than in-person physician-directed intake, nor was there any significant difference in the eventual outcome.

For rural hospitals, telemedicine has been found to decrease ED door-to-provider time and, among patients ultimately transferred to another facility, the length of stay was shorter for those patients who had a telemedicine consult. For certain groups of low-acuity older patients, another study found that ED telemedicine evaluation can provide safe and effective care.

Researchers studying the use of telemedicine in one ED found that the program allowed for the delivery of “high quality, efficient healthcare for low-acuity patients while not compromising patient experience.” For healthcare organizations exploring ways to increase their reach and throughput, researchers suggested “employing telemedicine as one method for evaluating low-acuity emergency department patients.”

Yet even as the accolades roll in for telemedicine in the ED, there remains a sense of urgency to find new, more innovative uses for the technology. Driving that are changes to reimbursement, specifically an expansion of the telemedicine services that the Centers for Medicare and Medicaid Services (CMS) will cover.

When it comes to implementing innovations, the ED remains at the forefront. For example, one health system is experimenting with a “teletriage” program to lighten the load in its busy ED. When patients visit the triage nurse, low-acuity individuals are now seen at the same time by a nurse practitioner via a telehealth monitor. This enables some patients to be treated on the spot or redirected to the system’s urgent care services when appropriate. The same health system is also experimenting with the provision of emergency care at home. In this case, some patients are sent home for observation via telemedicine vs. waiting it out in the ED—an experience that is far more comfortable for the patient and reduces costs.

As telemedicine continues to prove its worth, the industry will see increased and more innovative applications of this model in the ED. These trends hold great promise for relieving overcrowding and reducing high emergency care costs.

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