Telehealth’s Role in Emergency Care
NEJM recently published a case study on Stanford Health Care’s use of telehealth in the emergency department. The widely circulated article adds to a growing body of research examining the efficacy of virtual care programs.
Here’s what the study revealed.
In December 2020, Stanford launched its ED Virtual Visit Track (VVT), with the goal of accelerating the health system’s process of evaluating lower-acuity ED patients using a remote physician. “Supported by virtual visit–enabling hardware, software, workflow development, and training, as well as by VVT-trained support staff,” the remote physician virtually assesses low-acuity patients presenting at Stanford’s adult and pediatric ED sites.
Stanford emergency medicine physicians and research scientists compared the outcomes of 2,232 VVT patients to traditional ED patients over an 11-month period. “In a matched cohort of patients, the median ED length of stay (EDLOS) for VVT patients was 1.9 hours compared with 4.2 hours for patients cared for in the typical main ED workflow.”
Researchers also cited lower return visits among VVT patients, though differences were not statistically significant (6.7% vs. 7.2% for 72-hour revisits and 10.4% vs. 12.4% for 7-day revisits). All VVT physicians rated their ability to provide care that’s comparable to in-person care as very good or excellent.
What the Research Tells Us About Telehealth in the ED
Stanford researchers found that virtual care encounters in the ED were on par with, if not better than, in-person encounters for lower-acuity ED patients. Additional research findings paint a similar picture.
Research published in January 2022 that included a systematic review of 18 studies exploring the use of telehealth in emergency medicine found “strong evidence suggesting that the use of telemedicine positively impacts patient care.”
Clinical ED teams often use virtual workflows to screen and stratify patients who are better suited for an alternate care site or do not require in-person engagement. Real-time, video-based telehealth was most frequently identified as the most feasible supporting technology. Researchers also note that proper technical infrastructure to support virtual care, although challenging, is essential to program success.
Benefits of virtual emergency care cited within the 18 studies include:
- cost reduction
- improved quality of care
- decreased patient transfer rate from rural centers to major centers
- reduced mortality rate
- reduced patient treatment time
- reduced ED overcrowding
Additional Use Cases for Virtual Emergent Care
Care teams find similar success with telehealth-enabled EMS. Phone or tablet-based virtual consultations between paramedics in the field and remote emergency physicians can improve the speed of patient triage, diagnosis, and intervention before a patient ever makes it to the ED. By using virtual care to engage physicians while on-site or in transit with the patient, EMS responders can redirect lower-acuity patients away from high-cost care sites like the ED when appropriate.
CMS’ Emergency Triage, Treat, and Transport (ET3) model seeks to extend the applicability of telehealth in EMS. The ET3 payment program, currently being piloted, pays EMS participants for use of telehealth to initiate and facilitate patient treatment in place with a qualified healthcare provider for Medicare patients. It also expands Medicare reimbursement to include patient transports to alternative, lower-acuity care destinations like primary care offices and urgent care centers when emergency care is found to not be required.
We saw telehealth being similarly employed to support patient triage in the field during the COVID-19 pandemic, validating the essential role virtual care plays during public health emergencies. Telehealth-enabled field hospitals and curbside EDs were erected to manage patient surges and reduce overcrowding and exposure.
More recently, telehealth was used to support natural disaster emergency response for patients and clinicians impacted and displaced by Hurricane Ian. Evacuees relied on telehealth to maintain ties to providers, while out-of-state physicians and advanced practice nurses were given temporary rights to fill care gaps in Florida when local resources were impacted.
From emergency medical response in the field to virtual visit tracks in EDs, virtual care’s role in emergency medicine continues to mature. As Stanford researchers put it, “Although typically applied when a patient is outside of the care environment, a [virtual] program can be used in other situations in which options for in-person evaluation are limited.” As care teams manage overcrowded EDs and shrinking staff, virtual emergency care programs can provide much-needed relief.