Emergency Department Telemedicine Aids Patient Satisfaction

Adoption of telemedicine in emergency departments leads to better quality of care and patient satisfaction, according to a new study published in the INFORMS Journal Information Systems Research.

Emergency room telemedicine adoption shortened average length of stay and wait time significantly based on New York emergency room data from 2010 to 2014. This is a crucial finding as emergency departments face overcrowding and critical shortages of emergency care physicians, particularly as COVID-19 stresses hospital capacity across the country.

“While the ER is supposed to be a safety net of the health care system, the overcrowding problem has strained this safety net and posits various threats,” said Dr. Shujing Sun, lead author of the study and assistant professor of information systems in the Naveen Jindal School of Management.

“Long waiting times and treatment delays cause adverse patient outcomes, such as high readmission and mortality rates. They also increase financial costs, reduce patients’ satisfaction and impair physician efficiency,” Sun continued.

While telemedicine use has grown in recent years, there was little evidence on how it could be applied within the emergency department setting until now.

“Telemedicine application in the ER has two distinguishing features from home-based telemedicine. First, patients present in the ER. Second, on-site assistance is available to connect patients and off-site physicians throughout the telemedicine service,” Sun said.

“Off-site physicians can be within the same hospital, in a different hospital, or even at home, as long as they can connect with emergency patients through videoconferencing tools and have access to patients’ health records,” Sun continued.

Emergency room telemedicine improves an on-call physician’s efficiency through elimination of transportation, which can significantly shorten a patient’s wait time and increase overall patient satisfaction.

When there is an influx of patients in the emergency department, telemedicine allows nurse practitioners or physician assistants to treat patients with minor conditions on site with remote supervision from off-site physicians.

Additionally, having an on-call physician available through telemedicine can speed up the process of ordering lab work and allow physicians to complete their administrative tasks more quickly in between visits.

“Although the ER seems to be an unlikely place for telemedicine to play its role, it is happening, and in fact, is very promising. We believe our findings are critical for ERs, considering the unique setting of unscheduled arrivals and unpredictability of patient traffic,” explained Sun.

The researchers completed the same analysis using annual nationwide hospital data and found that emergency department telemedicine significantly reduces average wait times documented in Medicare.gov’s Hospital Compare.

The study also showed that telemedicine can significantly improve emergency room care delivery through flexibility of resource allocation, especially when a hospital lacks certain expertise or there is a shortage of on-site physicians.

For instance, the decision of whether to administer tissue plasminogen activator after stroke symptoms is a complex and time-sensitive medical decision, and some hospitals lack that expertise. Through an emergency room telemedicine application called a telestroke program, on-site physicians can immediately contact remote stroke specialists and receive treatment plans in a timely fashion.

“Although the ER seems to be an unlikely place for telemedicine to play its role, it is happening, and in fact, is very promising,” Sun said. “We believe our findings are critical for ERs, considering the unique setting of unscheduled arrivals and unpredictability of patient traffic.”

The study provides health care decision-makers with a close examination of the underlying implications of emergency department telemedicine use on quality of care, care delivery efficiency, and medical expenses.

“Due to the lack of evidence and the inflexibility of reimbursement policy, the adoption rate of telemedicine in the ER remains low and is growing only slowly. Policymakers can incentivize adoption of ER telemedicine by reducing regulatory barriers, such as lifting restrictions regarding cross-state practitioners’ licensure and providing better reimbursement coverage,” Sun noted.

“When more and more hospitals join the resource-sharing network, telemedicine will have great potential to rebalance the geographically imbalanced health care resources and reduce health care access disparity,” she continued.