Emergency rooms(ERs)are often crowded,expensive places to be.When used for their original intentions—to offer rapid medical assistance in emergency situations—they provide an essential service in the medical industry. However, when patients visit the ER due to lack of access to another provider, this can result in emergency room visits that are non-urgent. Reducing avoidable emergency department (ED) visits is an important health system goal.By enabling doctors to communicate with patients online, telehealth can save time for both medical professionals and patients.
Top 10 hospitals with the longest average ER wait times
Average (Median) Number of Minutes
Clovis Community Medical Center
Roseland Community Hospital
Community Regional Medical Center
NYC Health and Hospitals - Jacobi
Mount Sinai Medical Center
NYC Health and Hospitals - Kings County
NewYork-Presbyterian/Weill Cornell Medical Center
Kern Medical Center
Fig 1 Data from Definitive Healthcare's Hospital Platform using the Quality Metrics Search excluding Puerto Rico pulled January 2020. Numbers reflect the rate of the average (median) number of minutes patients spent in the emergency department before they were admitted to the hospital as an inpatient.
Longer wait times in hospital ERs contribute to overcrowding and delays in medication administration for patients with mid-level injuries and illnesses like broken bones and infections. Patient mortality rate is also higher when ER wait times are longer, though usually only by a small margin. According to one study, patient mortality rates rose from 2.5% with a wait time under two hours to a rate of 4.5% for patients waiting 12 hours or more.
Despite these figures, theCenters for Disease Control and Prevention(CDC) reports only 39 percentofERvisitsresulted in apatientbeingseen in fewer than 15 minutes. With the help of telemedicine intervention,emergency room visits could possibly beavoidediflow-acuitypatientsare able tospeak to a physician over the phone before deciding how topursue treatment.According to a study published in theJournal of Telemedicine and Telecare, telemedicine in a pre-hospital environment resulted in a 6.7 percent reduction in medically unnecessary ERvisits.
Patient education and ER visits
One of the simpler solutions to ERovercrowding could be greater patient education concerning medically-necessary reasons for a visit to the emergency department. A study from UC San Francisco (UCSF) found that nearly 3.3 percent of all ER visits over the past seven years led to patients being sent home without any administered care. According to patient volumes, that meansnearly 14 million patients visited the ER unnecessarily—clogging care access for other more high-risk or high-acuity patients.
These visits were primarily due to toothaches, back pain, headaches, throat soreness, and psychosis-related issues. Emergency departments are designed to care for patients with life- or limb-threatening issues, not specialty care. But some patients might not know where else they should go.
For patients, it can be difficult to determine whether they should visit the ER or an urgent care clinic. While ERs are intendedfor imminent danger, urgent or express care clinics are better equipped to handle fevers, sore throats, sprains, fractures, and other immediate—but not life-threatening—health concerns.
Top 10 hospital ERs with the highest percent of patients leaving before being seen
Republic County Hospital
Southern Regional Medical Center
Zuni Comprehensive Health Center
Bakersfield Heart Hospital
Centinela Hospital Medical Center
Southeast Health Center of Stoddard County
NYC Health and Hospitals - Woodhull
Desert Valley Hospital
Fig 2 Data from Definitive Healthcare's Hospital Platform using the Quality Metrics Search pulled January 2020. Numbers reflect the rate reported for percentage of patients who left the emergency department before being seen.
In some areas of the U.S., patients may visit the ER because they have few or no other choices. In the mid-south, dozens of patients may visit emergency departments between 60 and 80 times per year. For those with chronic pain, an ER may be the only place to get relatively fast relief, especially if their primary care physician isn’t knowledgeable about their particular illness. This new insight into “high-utilizers” and avoidable ER visits has alerted care providers to a lack of patient services—particularly surrounding mental health, dental care, and specialty services.
How telehealth helps reduce ER visits
With a smartphone or a laptop, it has become quite easy for patients to get medical attention right in the comfort of their own homes.Telemedicine technologies can help patients get faster opinions on their health concerns—encouragingthem to proceed with further in-person treatment, if needed. A University of Iowa study revealed that rural hospitals using telemedicine in their ERs saw patients six times more quickly than hospitals that did not use such technology.
Several startup companies, such as EmOpti and TeleMedCo, have developed virtual solutions to screen ER patients. These software companies act as telemedicine triage to expedite the more routine aspects of healthcare while increasing physician efficiency and optimizing health outcomes. As technology continues to expand, real-time monitoring with biometric data will lead to an increase in the types of cases that can be addressed remotely.
Beyond tech startups, large health systems are also taking matters into their own hands to improve wait times. To combat their consistently long wait times, NewYork-Presbyterian/Weill Cornell Medical Center(NYPWC) began utilizing telehealth in its emergency department. All low-acuity patients experience the same onboarding experience: triage nurses ask for the primary complaint and recordpatient vitals, and a nurse practitioner (NP) or physician assistant (PA) examines the patient to assessstability. If a patient is deemed to be in stable condition, they are eligible for the hospital’s express service. Express patients are then sent to their own room where they have a video conference with affiliated physicians in other areas of the NYPWC health system.
Since the express telehealth service was launched in July 2016, NYPWC has continuously expanded their virtual care delivery by launching the Hauser Institute for Health Innovation in 2019. This institute will have a specific focus on remote patient monitoring and teleparamedics with an overarching goal of providing high-quality, convenient, and affordable care with an emphasis on preventive health and wellness.