A 15 minute read
telehealth
September 8, 2017

*updated January 2020

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 

Rank Hospital Name Definitive ID State Average (Median) Number of Minutes
1 Clovis Community Medical Center 328 CA 1,451
2 Roseland Community Hospital 1167 IL 948
3 Highland Hospital 274326 CA 916
4 Grady Hospital 996 GA 899
5 Community Regional Medical Center 325 CA 803
6 NYC Health and Hospitals - Jacobi 2755 NY 780
7 Mount Sinai Medical Center 2837 NY 768
8 NYC Health and Hospitals - Kings County 2806 NY 746
9 NewYork-Presbyterian/Weill Cornell Medical Center 541974 NY 726
10 Kern Medical Center 345 CA 711

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, 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.  

Patient education and ER visits

One of the simpler solutions to ER overcrowding 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 careAccording to patient volumes, that means nearly 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 intended for 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

Rank Hospital Name Definitive ID State Percentage
1 Republic County Hospital 1604 KS 20%
2 Southern Regional Medical Center 963 GA 18%
3 Zuni Comprehensive Health Center 2730 NM 16%
4 Bakersfield Heart Hospital 349 CA 14%
5 Oroville Hospital 309 CA 13%
6 Centinela Hospital Medical Center 419 CA 11%
7 Grady Hospital 996 GA 10%
8 Southeast Health Center of Stoddard County 2435 MO 10%
9 NYC Health and Hospitals - Woodhull 2810 NY 10%
10 Desert Valley Hospital 531 CA 10%

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 concernsencouraging 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 experience: 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 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.

Learn more: 2020 healthcare trends

Are you interested in understanding how telemedicine and alternative care delivery models will impact healthcare in 2020 and beyond? Join Definitive Healthcare CEO Jason Krantz on January 29 at 2 pm EST for our first webinar of the year: 8 Top-Of-Mind Trends for Physician and Hospital Buyers in 2020.

Webinar attendees will gain insights on key topics such as: 

  • How technology continues to push boundaries in healthcare
  • The evolving role of data accessibility and security
  • What’s next for value-based care delivery

Make sure you’re prepared for a shifting market and a new decade! Register for 8 Top-of-Mind Trends for Physician and Hospitals Buyers in 2020 today! 


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