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Hospitals Turn to Telemedicine to Tackle ER Triage, Overcrowding

Health systems are using telemedicine and mHealth to screen patients coming into their ERs, improving wait times and patient satisfaction and making sure their ER staff are seeing the right people.

Source: ThinkStock

By Eric Wicklund

- A telemedicine platform that helps emergency departments triage patients just might be the answer to crowded ERs and physician staffing issues.

 The virtual visit platform, developed by the Wisconsin-based startup EmOpti, is currently being used in eight hospitals in four health systems: Wisconsin’s Aurora Health Care, MedStar in Washington D.C., Philadelphia’s Thomas Jefferson University Hospitals and Charlotte, N.C.-based Carolinas HealthCare.

In those hospitals, patients admitted to the ED who aren’t immediately seen by a doctor can be seen by secure video-conferencing technology by a doctor or physician assistant in a remote “command center.” The physician or PA examines the patient with the help of on-site triage nurses and can order tests or prescribe medications.

The hub-and-spoke telemedicine model enables one command center to manage multiple hospital EDs, while ED doctors at those hospitals are focused on patients most in need of emergency care.

“It’s a change in how you triage patients,” Paul Coogan, president of emergency services at Aurora, which has three hospitals using the telemedicine service, told Xconomy. “There was initially some resistance. The nurses thought it was going to add a lot of time to triage. [But] I think they appreciate having some extra help.”

The ER sits at the apex of the hospital crowding/staff shortage dilemma, according to the Centers for Disease Control and Prevention. While the number of ER visits jumped 36 percent from 1995 to 2010 – from 97 million to 130 million – the number of ERs in the country dropped by 11 percent. This leads to more crowded EDs and longer wait times, and puts considerable stress on staff, patients and – ultimately – clinical outcomes.

Health systems have been looking at innovative telemedicine and mHealth services to ease patient congestion in their EDs and help make the best use of a limited physician pool. Of particular interest are platforms that allow the health system to screen incoming patients, referring the life-threatening cases to on0site staff while either treating non-acute cases through telehealth or referring them to other services.

The products being tested range from kiosks to automated registration platforms to wearables and other smart devices that quickly capture patient vitals and data. And some healthcare providers are even looking at smartglasses, such as the latest iteration of Google Glass, to help ER nurses improve the triage process.

In Kentucky, Blanchfield Army Community Hospital in Fort Campbell used a telemedicine platform in its busy ED to treat non-emergency cases. Those patients were seen via virtual visit by primary care doctors at Eisenhower Army Medical Center in Augusta, Ga., some 445 miles away.

A Florida-based startup, meanwhile, is combining a telehealth communications platform with IBM’s Watson software to screen patients coming into the ER and direct them to the right services.

Large health systems like the University of Mississippi Medical Center – recently designated a National Telehealth Center of Excellence – use telemedicine platforms to help smaller hospitals treat more of their ER patients rather than transferring them to larger institutions.

A study of 15 of the state’s hospitals using the UMMC platform to treat some 500,000 patients saw a 25 percent reduction in a hospital’s staffing costs, while the hospitals saw a 20 percent increase in admissions – patients who would have been transferred to UMMC for ultimately non-serious issues, depriving the local hospital of revenues and taxing UMMC’s resources.

The concept can also help smaller hospitals quickly access specialist services. The Robert Wood Johnson Community Hospital in Somerset, N.J., for example, uses telemedicine to connect with Bristol-Myers Squibb Children’s Hospital for emergency department pediatric consults.

With EmOpti, Coogan said Aurora’s three hospitals have seen their ER stays reduced by about 45 minutes. The health system’s command center is at St. Luke’s Hospital in Milwaukee, while the three hospitals are as much as 30 miles distant.

“We’re able to put this in front of a patient within 10 minutes,” Mike Rodgers, the health system’s director of strategic innovation, told Xconomy. “We ask patients for feedback and have so many quotes. [They say], ‘I’m going to come back here because I actually see a doctor.’”

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