San Francisco VA Uses Telehealth to Triage, Reduce ED Traffic

A nurse-based telehealth platform is helping to reduce emergency room congestion and improve timely clinical outcomes at a Veterans Affairs health system.

In a study recently published in Emergency Medicine International, researchers from the University of California at San Francisco analyzed the effectiveness of a service at the San Francisco VA health system that allows veterans to call a nurse for advice on an urgent care concern. The call center was supported by urgent care clinicians with access to a telemedicine platform.

Over a four-month period in 2019, researchers looked at 104 cases in which the nurse recommended telehealth instead of a visit to the ED; 78 of those cases were handled with a virtual visit (audio-visual platform) and the other 26 were conducted through a phone call. In all, 92 cases were successfully handled via telehealth, with 21 diverted away from the ED, and eight cases eventually ended up at the hospital.

“Adoption of virtual urgent care has risen dramatically over the last decade, but few such programs have been linked with a nurse telephone advice line,” the researchers, led by Amy Lu, an assistant professor of medicine at the Denver Health and Hospital Authority, reported in the study. “Our pilot program demonstrated the feasibility of a seamless transfer of patients from an existing nurse-led telephone triage line to an immediate virtual evaluation by an urgent care provider. In over 85 percent of cases, the first contact resolution was achieved immediately.”

Of those who issues weren’t resolved via telehealth, researchers noted the most common reasons were technical difficulties (unable to connect via video or assess by telephone) and a patient’s preference for in-person care.

The study shows the value of connected health in ED triage – a particularly valuable tool given the challenges faced by hospitals during the coronavirus pandemic. With an advice line staffed by nurses and a telehealth platform in support, hospitals can screen patients before they leave their homes and funnel them more quickly and accurately to the right level of care.

Regardless of the COVID-19 emergency, hospitals have been adopting telehealth platforms to handle non-acute ED traffic for some time, most often through a direct-to-consumer platform accessible via phone, online portal or through an mHealth app. In some cases, they’ve installed telemedicine stations or kiosks in the ED, allowing patients to check in and perhaps be seen via virtual visit rather than waiting around for on-site care providers.

With hospitals struggling to make ends meet and facing competition from telehealth vendors, stand-alone urgent care providers and others, an easy-to-use platform that improves ED workflows and meets patient demands would be well-received.