Dr. Erkan Hassan

Monthly Writings

Evaluations and reviews of the latest in the field.

Telemedicine in the Emergency Department

SUMMARY:

  • Increased emergency department (ED) demand, staff shortages and hospital consolidations have led to overcrowded ED’s.

  • Virtual ED care, is a proposed alternative service model to potentially alleviate ED overcrowding.

  • There are a number of potential benefits to virtual ED services, but various challenges as well.

REVIEW

  • ED’s are typically crowded with post pandemic number of visits exceeding pre-pandemic numbers.

  • In 2021 there were approximately 139.8 million ED visits vs 130 million in 2018.

  • Over 27% of ED visits have been proposed able to be managed in alternative settings.

  • Tele-ED service models are typically decentralized, with a remote emergency physician functioning as a specialist on call.

Tele-ED Service Model

  • Published studies typically have all patients initial triaged by the virtual ED.

  • Collected health data and evaluations to determine the level of care required by the patient are then determined for optimum outcomes.

  • Proposed benefits of Tele-ED include:

    • Improved quality of care

    • Decreased patient transfer rates from rural to major centers

    • Reduced mortality rates

    • Reduced first contact and treatment

    • Cost reduction

  • Identified Challenges include:

    • Technical issues and difficulties

    • Regulatory issues

    • Security (patient confidentiality)

    • Limited literature on technology implementation

  • Weak study designs of most studies limit a conclusive confirmation of benefits.

Tele-ED Benefits & Challenges

  • A summary of 2 Australian studies (19,026 patients) initially seen via virtual ED or Urgent Care demonstrates:

    • 3,566 (18.7%) were referred to the ED

    • 856 (24.0%) of referred patients did not go to the ED

    • 375 (13.8%) of patients were admitted to the hospital after ED referral

    • 328 (2.1%) of patients not referred to the ED were admitted to the hospital

  • Tele-ED services have been reported to produce a cost savings of $1,832 per person after accounting for total operational and ambulance savings.

    • This is an estimated ROI ratio of 1.12

Tele-ED Outcomes

CONCLUSIONS:

  • There is both favorable and controversial evidence on the use of telemedicine within the emergency department.

  • An estimated 27% of ED visits may be better managed in alternative settings.

  • Conversely, only a very small percentage of patients (2.1%) were admitted to the hospital after a tele-ED visit where referral to the hospital not occur.

  • Further clinical validations are needed.

Erkan Hassan