A 17 minute read
Distressed looking doctor uses a laptop with an old-fashioned alarm clock on the desk in front of him
June 15, 2020

*updated June 2020

When used for their original intentions, emergency departments provide essential life-saving medical services. However, when patients visit the ER due to lack of access to another provider, this can result in unnecessary, non-urgent emergency room visits—at high costs to patients and providers.

Unnecessary emergency department (ED) visits cost more than $8.3 billion annually, making them a valuable target for providers seeking to reduce care costs. By enabling doctors to communicate with patients virtually, telehealth is one way for providers and patients to save time and money. 

Expediting emergency care with telehealth

With the widespread use of smartphones and laptops, it has become easier for patients to seek medical attention from the comfort of their own homes. Telemedicine technologies can help patients get faster opinions on their health concerns—encouraging them 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: triage nurses ask for the primary complaint and record patient vitals, and a nurse practitioner (NP) or physician assistant (PA) examines the patient to assess stability. 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 has 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.

Top 10 hospitals with longest average ER wait times before patient discharge

Rank Hospital Name Definitive ID Avg Wait Time (Minutes) Staffed Beds Discharges
1 Santa Cruz Valley Regional Hospital 582189 475 49 1,718
2 Manati Medical Center 4649 471 251 14,085
3 Doctors Center Hospital Bayamon 4635 405 146 8,214
4 Ben Taub Hospital 274186 374 444 28,163
5 Grady Hospital 996 365 659 33,496
6 Northeastern Vermont Regional Hospital 4245 354 25 1,794
7 Beth Israel Deaconess Medical Center 1970 344 694 39,871
8 UC San Diego Medical Center - Hillcrest 550 337 381 33,464
9 Sage Memorial Hospital 143 335 25 244
10 Doctors Center Hospital Miami 4650 321 262 15,138

Fig 1 Data from Definitive Healthcare's Hospitals & IDNs database  using the Quality Metrics Search. Data collection period spanned from July 1, 2018 to June 30, 2019, and was released in April 2020. Numbers reflect the rate of the average (median) number of minutes patients spent in the emergency department before being discharged. Data accessed June 2020.

Longer emergency department wait times contribute to overcrowding and delays in medication administration for patients with mid-level injuries and illnesses (like broken bones and infections) as well as greater risk of patient exposure to medical error. Patient mortality rate is also higher with longer wait times, though usually only by a small margin and for patients older than 80. 

Despite these figures, the most recent report available from the Centers for Disease Control and Prevention (CDC) reports only 39 percent of ER visits resulted in a patient being seen in fewer than 15 minutes.

With the help of telemedicine intervention, emergency room visits could possibly be avoided if low-acuity patients are able to speak to a physician over the phone before deciding how to pursue treatment. According to a study published in the Journal of Telemedicine and Telecare, telemedicine in a pre-hospital environment resulted in a 6.7 percent reduction in medically unnecessary ER  visits

Top 10 hospitals with longest ER wait times before patient admission

Rank Hospital Name Definitive ID Avg Wait Time (Minutes) Staffed Beds Discharges
1 Clovis Community Medical Center 328 1,326 208 15,769
2 Highland Hospital 274326 1,072 169 10,580
3 Harney District Hospital 3392 786 19 321
4 Community Regional Medical Center 325 627 663 35,323
5 Grady Hospital 996 600 659 33,496
6 University of Puerto Rico Hospital 4640 549 233 8,032
7 Mayaguez Medical Center 4652 530 192 8,851
8 Loma Linda University Medical Center 519 506 463 22,810
9 UK Albert B Chandler Hospital 274110 501 524 45,156
10 George Washington University Hospital 748 500 329 22,598

Fig 2 Data from Definitive Healthcare's Hospitals & IDNs database  using the Quality Metrics Search. Data collection period spanned from July 1, 2018 to June 30, 2019, and was released in April 2020. Numbers reflect the rate of the average (median) number of minutes patients spent in the emergency department before being admitted to the hospital. Data accessed June 2020.

How can hospitals reduce ER overcrowding?

Patient education is one of the simpler solutions to ER overcrowding. A study from UC San Francisco (UCSF) found that nearly 3.3 percent of all ER visits in a seven-year period led to patients being sent home without any administered careBy volume, that means nearly 14 million patients visited the ER unnecessarily—clogging care access for more high-risk or high-acuity patients.

Many of the visits recorded in the study were non-emergency complaints like 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, an urgent care clinic, or make an appointment with a primary care physician. While ERs are intended for imminent danger, urgent 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 highest percentage of patients who left before being treated

Rank Hospital Name Definitive ID Percentage of Patients Staffed Beds Discharges
1 Washington County Regional Medical Center 1066 20 56 457
2 Capital Medical Center 4408 17 107 4,898
3 SSM Health St Marys Hospital - St Louis 2425 16 634 28,259
4 Oroville Hospital 309 16 133 13,372
5 Southern Regional Medical Center 963 13 244 10,572
6 University of Maryland Medical Center 1920 13 767 26,014
7 Jefferson County Hospital 2281 12 12 96
8 NYC Health and Hospitals- Lincoln 2753 12 287 18,730
9 Roseland Community Hospital 1167 11 134 2,226
10 St Francis Hospital 1038 10 312 13,518

Fig 3 Data from Definitive Healthcare's Hospitals & IDNs database  using the Quality Metrics Search. Data collection period spanned from January 1, 2018 to December 31, 2018, and was released in April 2020. Numbers reflect the percentage of patients who left the emergency department before being seen by a physician. Data accessed June 2020.

In some areas of the U.S., patients may visit the ER because they have few or no other choices. In rural areas, patients 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.

Learn more: 2020 healthcare trends

Are you interested in understanding how COVID-19 is changing the way telemedicine  and alternative care delivery models are impacting healthcare?

Join Definitive Healthcare CEO Jason Krantz on June 24 at 2 pm EST for our webinar, Updated Healthcare Industry Trends: Selling To Doctors And Hospitals In A Changed Market.

Ensure that your business is prepared for the new healthcare market post-COVID-19—register today!


ABOUT THE AUTHOR

Alanna Moriarty

Alanna Moriarty is a healthcare industry writer and content strategist. As the Content Marketing Manager for Definitive Healthcare, she most enjoys connecting the dots between data and care delivery. ...


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