Will Telemedicine Improve Emergency Department Care?

Telemedicine may be increasingly used in emergency departments throughout the United States, depending on the outcomes of various studies.  A project in California will determine whether telemedicine can decrease patients’ wait times, while other studies suggest that the use of telemedicine can improve outcomes for pediatric patients.

U.C.-San Diego Health System Pilot Project

The UC-San Diego Health System has launched a pilot project to study the use of telemedicine in emergency departments (EDs) to deal not with issues of geography, but efficiency.  The Emergency Department Telemedicine Initiative to Rapidly Accommodate in Time of Emergency (EDTITRATE) is intended to prevent patients from waiting too long to be evaluated by a physician and will, hopefully, prevent patients from leaving EDs before an evaluation occurs.  The study is funded by a $50,000 University of California Health Quality Improvement grant.

Patients must sign a consent form before participating in the study, which may be activated during busy times, Monday through Friday.  Essentially, when the physicians physically present in the ED become too busy, patients may see an on-call doctor via a telemedicine station located in the ED.  Aided by ED nurses, a physician may examine a patient’s eyes, ears, nose, throat, and skin via video and listen to heart and lung sounds.  Off-site physicians can also order and view laboratory and imaging tests.  Patients participating in the pilot will be reassessed by an on-site physician.

The theory behind the project is that patients in busy EDs will not have to wait to speak to a physician when those on-site are busy and will also not have to wait for an on-call doctor to arrive at the ED.  David Guss, M.D., principal investigator and chair of emergency medicine at the UC-San Diego School of Medicine, notes that the system could benefit hospitals, as well.  ED patient loads vary at different times.  Says Guss, “Some emergency departments have placed a physician in the triage area to expedite care, however, if there is low demand for service during these times, an underutilized physician creates an unneeded expense.”

Pediatric Telemedicine

The American Academy of Pediatrics (AAP) has also suggested that the use of telemedicine in EDs may prevent transfers of children physically present in facilities where staff are uncomfortable with or inexperienced in caring for children.  More than 15 U.S. hospitals provide pediatric telemedical consultations to patients at remote, rural, or underserved EDs.  The patient, parent, and referring physician are all present for the audio and video interaction with the off-site pediatric specialist.  The AAP referenced two studies that demonstrated higher quality of care outcomes, based on process measures and lower medication error rates, for telemedical consultations, as opposed to phone consultations.  It also noted that the use of laptops, tablets, and other mobile devices, are more cost-effective than larger videoconferencing systems.

Licensing, cost, and physician and patient attitudes will weigh heavily in telemedicine decisions.  However, should continued research suggest improved quality of care, EDs across the country may begin to seriously consider the option.