Dr. Erkan Hassan

Monthly Writings

Evaluations and reviews of the latest in the field.

The Future of Emergency Department Telemedicine

Telemedicine Has Created Ideal Opportunities For New And Alternative Models For Emergency Care

Summary

  • Emergency care will transcend the four walls of the emergency department.

  • Virtual emergency department visits will change the concept of the traditional waiting room.

  • Telemedicine will transform triage, testing, consulting and treatment.

Review

EMERGENCY DEPARTMENT (ED) SUMMARY (CDC 2018):

  • 129,974,000 annual visits

  • Most patients spent 2 -4 hours (34.8%) in the ED

  • 12.4% are admitted to the hospital with a mean length of stay of 5.8 days

  • 1.2% are left without being seen

  • Telemedicine will allow for the creation of new and alternative models of emergency care.

BEYOND THE 4 WALLS OF THE ED:

  • Most patients seen in the ED do not have true medical emergencies.

  • The future will be provision of emergency care independent of location.

    • Emergency Care will replace Emergency Department

  • Therefore, emergency care expertise is the common denominator, not the physical location.

  • Telemedicine can be used to leverage the delivery of acute and urgent care independent of emergency departments.

VIRTUAL EMERGENCY CARE VISITS WHERE NEEDED:

  • To improve operational efficiency, we need to move beyond the concept of the traditional ED waiting room.

  • Asynchronous telemedicine alternatives will allow for e-visits, chat-bots, text messages, smartphone apps, etc.

  • Synchronous telemedicine evaluation is ideal for specialty consultation and advanced testing.

  • These systems will expedite triage, from the moment a patient is identified.

    • Is the patient unlikely to need an in-person ED visit?

    • Can diagnostic testing be completed at outpatient facilities?

    • Can testing be accomplished and patient follow-up occur virtually?

    • Refer patient to appropriate primary care or specialist provider

  • These changes to triage, testing, consulting and treatment will:

    • Improve operational efficiency

    • Shorten the time the patient spends in the ED

    • Decrease walkout rates

 DISCHARGE TO HOSPITAL AT HOME:

  • Patients can enter Acute Care at Home program directly from ED.

  • Demonstrated to be an effective alternative in a select group of patients

  • Decreases cost of care; 30 Day ED visits; 30 Day Readmissions

CONCLUSIONS:

  • Telemedicine will change emergency care delivery in the future.

  • The ED will not be eliminated, however, the design and workflows must be reconsidered and optimized.

  • The physical ED will likely lead to an increased percentage of patients being hospitalized.

  • However, the development of virtual emergency care will render care to non-emergency needs in a lower cost environment.

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Erkan Hassan