New Research: Telehealth Emergency Care Leads to Decreased Emergency Department Visits & Hospitalizations, Reduced Health Care Costs
A new study exploring telehealth emergency care showed Veterans who utilized a new tele-emergency service were nearly half as likely to visit an emergency department in-person and showed reduced short-term Veteran visits to emergency departments outside of VA.
The findings, published in the journal Academic Emergency Medicine, have important implications for emergency care such as reducing the cost of VA health care and reducing the overall burden on emergency departments dealing with a high number of patient visits with conditions that may be better addressed by urgent care or primary care.
“Tele-emergency care is really about talking patients through a risk-benefit calculation about whether they should go to an emergency department,” said Dr. Kathy Li, Acting Instructor at the University of Washington’s Department of Emergency Medicine, and former member of Michigan Medicine’s Clinical Faculty.
Dr. Li’s study drew results from a pilot tele-emergency care (tele-EC) service at VA Ann Arbor Healthcare System (VAAAHS) from January through December of 2021. Veterans called the VAAAHS call center with a symptom-based complaint and were assessed using a standard nurse triage protocol. Based on the responses from the Veteran, the protocol guides triage nurses to recommend how urgently the Veteran should be seen – ranging from calling 911 for the most serious concerns to same-day care, self-care, or routine follow-up for low-acuity concerns.
More specific to Dr. Li’s study, Veterans who were recommended by the triage nurse to seek care within 24 hours were offered a tele-emergency care visit. Essentially, the Veteran could speak with an emergency physician by video or phone call without physically visiting the emergency room.
Veterans who were advised to immediately call 911 because of the seriousness of their symptoms were only offered a tele-EC visit if they declined to seek immediate, in person emergency care.
“As someone without medical training, it can be hard sometimes to know if your symptoms may be dangerous or not. You don’t want to go when it’s not necessary, but you also don’t want to say home if it’s dangerous,” explained Dr. Li.
Dr Li’s study compared the number of Veterans who visited the ED in-person after speaking only with the triage nurse against those who also had a tele-EC visit with a physician.
Thirty-five percent of Veterans who spoke only with the triage nurse made an in-person ED visit within 7 days of their initial phone call. However, only 18% of Veterans made an in-person ED visit if they consulted first with an emergency physician utilizing tele-EC.
Importantly, there were also lower associated rates of hospitalization among the tele-EC group, and no deaths in either study group.
“That has a measurable impact on the number of low acuity ED visits. Those low acuity visits don’t add a lot of value for the patient or provider, and tele-EC visits are able to prevent those,” explained Dr. Li. “It’s not just valuable for low-acuity visits though. On the flip side, I have also used it to convince Veterans who were hesitant to go to the ED why they really needed to go, which can prevent potentially dangerous delays in care.”
Additionally, the lower number of visits to non-VA emergency departments because of the tele-EC consultation reduced VA spending.
“Tele-emergency care, if you had that visit, it was associated with $248 reduced spending on just community care ED visits. That’s not even counting most ED visits, which were visits to the VA emergency department,” Dr. Li said.
Dr. Li explains that when all these factors are considered together, tele-EC has the potential to address a wide variety of clinical conditions and reduce the need for in-person ED care.
“I think that tele-emergency care has the potential to decrease avoidable ED visits in a meaningful way, while doing so in a very patient-centered way. This is not a computer algorithm telling you to go to the emergency room or not. This can add that humanness and patient-centeredness back into that decision. You have a real risk-benefit discussion with real people,” Dr. Li said.