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Telehealth has been widely accepted in a variety of disciplines, and most hospitals have embraced it in at least a limited capacity. However, there remains uncertainty about how telehealth fits within the emergency medicine care model. While COVID-19 created a lot of hype around telehealth, the reality is that the need for virtual solutions in the emergency department (ED) long preceded COVID-19.
It’s time to clarify what telehealth looks like in the emergency department setting and how it is solving some of the most long-standing challenges in emergency medicine.
We have worked with facilities, large and small, throughout the country. A few questions we have heard:
- Is there a certain threshold that we should be looking at to determine if/when a tele-ED solution makes sense?
- Are virtual providers in-place-of or in-support-of our bricks-and-mortar physicians?
- Is it a 24/7/365 application?
The short answer is that there is no one size fits all solution, and what works wonderfully for one facility may prove problematic for another. The longer answer is that emergency departments have struggled for a long time to identify practical solutions that effectively cater to their specific challenges. The nature of traditional staffing models is predictable, nine- or twelve-hour shifts. On the flipside, emergency medicine isn’t neat or predictable. Administrators tend to staff based on weekly, monthly, or even yearly visit volume trends. In contrast, clinicians and providers know that the minute-by-minute and hour-by-hour changes are really where the challenges are. Bottlenecks occur at different points in the ED patient flow based on current staffing, volume fluctuations, and other factors.
Each situation must be looked at uniquely to debunk pre-existing assumptions and think creatively about how non-traditional applications of technology can solve problems that, frankly, have become the norm. A few key statistics to note:
- Average ER providers can see between nine to twenty-five consults in an hour, depending on provider experience and patient acuity levels.
- A virtual provider can triage up to 120,000 annual visits per year.
- It is estimated that approximately 70%-80% of all ER visits are suitable for virtual triage, meaning they aren’t high acuity in the “seconds to minutes” range for life-saving treatment.
When we speak about tele-ED solutions, we’re not just talking about one thing. We are talking about a number of solutions that can help solve a myriad of challenges. Emergency care has evolved to include various virtual solutions, including Tele-EMS and direct-to-consumer emergency telemedicine (ED2Home). Speaking strictly within the four walls of the ED, we have identified three primary applications in collaboration with our hospital partners. These include:
Tele-Triage. With tele-triage, a virtual provider is placed in triage. The triage nurse has quick, easy access to their triage provider, allowing them to triage patients with that nurse. They then place patient’s orders directly into the EMR and expedite the patients’ care. While some facilities already have implemented a provider in triage, the virtual nature of this process eliminates a lot of wasted time and distraction. Our virtual providers are averaging around two minutes to triage remotely.
Tele-Discharge. With tele-discharge, a virtual provider can be leveraged to expedite the discharge process for low-acuity patients. Ground providers in high-volume, high-acuity settings have pressure to balance their sicker patients taking up bed space and making calls for transfer or admission with the lower acuity patients who need discharging and education for follow-up care. Two issues occur:
- the system becomes clogged
- discharged patients aren’t given the proper time to discharge instructions, elevating their risk for readmission.
We are proving that tele-discharge can free up the overcrowded ED, improve patient satisfaction, and reduce readmissions.
Tele-Collaboration. With tele-collaboration, a virtual provider has access to collaborate in real-time with APPs in the ED. APP and physician collaboration is an essential standard for quality care. However, if multiple APPs are working in the ED and only one or few ED physicians, proper collaboration becomes difficult, and bottlenecks occur. Providing APPs access to a virtual ED physician allows them to collaborate effectively and expedite care while freeing up the ED physician.
What have we learned so far? We have implemented each of the above solutions at a number of facilities and what we have learned is that each facility must be treated uniquely. We start by doing an in-depth analysis of the existing operations to understand what is working and what isn’t. While Keystone HealthcareTM offers a complete, 24/7/365, nationwide network of ED physicians and APPs, the application of that infrastructure can be much more limited in scope while still having a huge impact.
We do not “set it and forget it.” One of the biggest misconceptions is that a problem can be identified and addressed in isolation. Emergency medicine is as much of an art as it is a science, and failing to understand the complexity of the system and the adverse implications that one piece of the puzzle has on the others can be detrimental. Therein lies our expertise. We go beyond the simple, plug-and-play solution and instead work to architect and optimize the entire emergency medicine program.
If you’re interested in learning more about how to efficiently deliver high-quality, patient-centered care in and to allow your hospital to thrive in the current health care environment, Keystone HealthcareTM is ready to help. Contact us today.