Do Hospitals Providing Telehealth in Emergency Departments Have Lower Emergency Department Costs?

Williams, Dunc; Simpson, Annie N.; King, Kathryn; Kruis, Ryan; Ford, Dee W.; Sterling, Sarah A.; Castillo, Alexandra; Robinson, Cory O; Simpson, Kit N.; Summers, Richard L.

doi:10.1089/tmj.2020.0349

Cited by 7 publications

(9 citation statements)

References 29 publications

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“…The use of telehealth in EDs has been associated with estimated lower total annual ED costs and improved quality via reduced ED length of stay and waiting time. 29 , 32 Conversely, clinician-in-triage models have been associated with improved quality via reduced ED crowding, ED length of stay, and rate of leaving without being seen but also with increased costs to EDs and lack of cost-effectiveness. 23 , 24 , 25 , 26 , 27 Split-flow models and discharge lounges have been linked to improved quality via improved efficiency, reductions in ED length of stay, and reductions in ED crowding, 27 , 28 , 29 , 30 , 31 although to our knowledge, assessments of costs (and thereby value) are lacking.…”

Section: Discussionmentioning

confidence: 99%

“… 29 , 32 Conversely, clinician-in-triage models have been associated with improved quality via reduced ED crowding, ED length of stay, and rate of leaving without being seen but also with increased costs to EDs and lack of cost-effectiveness. 23 , 24 , 25 , 26 , 27 Split-flow models and discharge lounges have been linked to improved quality via improved efficiency, reductions in ED length of stay, and reductions in ED crowding, 27 , 28 , 29 , 30 , 31 although to our knowledge, assessments of costs (and thereby value) are lacking. Our findings add to this body of literature by providing costs associated with implementing an ED-ICU to complete the assessment of value.…”

Section: Discussionmentioning

confidence: 99%

“… Previous work has investigated the impact of other novel care delivery mechanisms on component(s) of value in emergency medicine, including telehealth, clinician in triage, split flow, and discharge lounges. The use of telehealth in EDs has been associated with estimated lower total annual ED costs and improved quality via reduced ED length of stay and waiting time . Conversely, clinician-in-triage models have been associated with improved quality via reduced ED crowding, ED length of stay, and rate of leaving without being seen but also with increased costs to EDs and lack of cost-effectiveness .…”

Section: Discussionmentioning

confidence: 99%

“…Prior studies 22 This analysis reports the direct ED and hospital system costs associated with a novel care delivery mechanism (the ED-ICU), allowing completion of the value equation when paired with prior quality data (Figure 2). 13 Previous work [23][24][25][26][27][28][29][30][31][32] has investigated the impact of other novel care delivery mechanisms on component(s) of value in emergency medicine, including telehealth, clinician in triage, split flow, and discharge lounges. The use of telehealth in EDs has been associated with estimated lower total annual ED costs and improved quality via reduced ED length of stay and waiting time.…”

Section: Jama Network Open | Emergency Medicinementioning

confidence: 99%

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Cost-effectiveness of an Emergency Department–Based Intensive Care Unit

et al. 2022

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ImportanceValue in health care is quality per unit cost (V = Q/C), and an emergency department–based intensive care unit (ED-ICU) model has been associated with improved quality. To assess the value of this care delivery model, it is essential to determine the incremental direct cost of care.ObjectiveTo determine the association of an ED-ICU with inflation-adjusted change in mean direct cost of care, net revenue, and direct margin per ED patient encounter.Design, Setting, and ParticipantsThis retrospective economic analysis evaluated the cost of care delivery to patients in the ED before and after deployment of the Joyce and Don Massey Family Foundation Emergency Critical Care Center, an ED-ICU, on February 16, 2015, at a large academic medical center in the US with approximately 75 000 adult ED visits per year. The pre–ED-ICU cohort was defined as all documented ED visits by patients 18 years or older with a complete financial record from September 8, 2012, through June 30, 2014 (660 days); the post–ED-ICU cohort, all visits from July 1, 2015, through April 21, 2017 (660 days). Fiscal year 2015 was excluded from analysis to phase in the new care model. Statistical analysis was performed March 1 through December 30, 2021.ExposuresImplementation of an ED-ICU.Main Outcomes and MeasuresInflation-adjusted direct cost of care, net revenue, and direct margin per patient encounter in the ED.ResultsA total of 234 884 ED visits during the study period were analyzed, with 115 052 patients (54.7% women) in the pre–ED-ICU cohort and 119 832 patients (54.5% women) in the post–ED-ICU cohort. The post–ED-ICU cohort was older (mean [SD] age, 49.1 [19.9] vs 47.8 [19.6] years; P &lt; .001), required more intensive respiratory support (2.2% vs 1.1%; P &lt; .001) and more vasopressor use (0.5% vs 0.2%; P &lt; .001), and had a higher overall case mix index (mean [SD], 1.7 [2.0] vs 1.5 [1.7]; P &lt; .001). Implementation of the ED-ICU was associated with similar inflation-adjusted total direct cost per ED encounter (pre–ED-ICU, mean [SD], $4875 [$15 175]; post–ED-ICU, $4877 [$17 400]; P = .98). Inflation-adjusted net revenue per encounter increased by 7.0% (95% CI, 3.4%-10.6%; P &lt; .001), and inflation-adjusted direct margin per encounter increased by 46.6% (95% CI, 32.1%-61.2%; P &lt; .001).Conclusions and RelevanceImplementation of an ED-ICU was associated with no significant change in inflation-adjusted total direct cost per ED encounter. Holding delivery costs constant while improving quality demonstrates improved value via the ED-ICU model of care.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Jama Network Open | Emergency Medicinementioning

confidence: 99%

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Cost-effectiveness of an Emergency Department–Based Intensive Care Unit

et al. 2022

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“…The acceleration of Telemedicine in recent years has established itself as an effective and safe strategy for sharing knowledge among professionals, reducing cases of low complexity in emergencies, and optimizing access to health in remote regions 18,19 . In services whose demand for subspecialists is small or low regional availability of professionals, it is economically unfeasible to maintain them in person at each health unit 20,21 . In this context, the exchange of experience in real-time between the emergency room and other specialists at a distance, such as cardiologists and neurologists, can be crucial for the assertive management of highly complex cases 22,23 .…”

Section: Editorialmentioning

confidence: 99%

Novas tecnologias e excelência na unidade de emergência

Accorsi

Cardoso

Paixão

et al. 2021

Rev. Med. (São Paulo)

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Factors Affecting Telemedicine Implementation in Emergency Departments and Nurses' Perceptions of Virtual Sexual Assault Nurse Examiner Consultation for Sexual Assault Survivors

Allison

Curran

Walsh

et al. 2022

Journal of Forensic Nursing

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Introduction Emergency department (ED) nurses play a critical role in caring for sexual assault patients, but many have not received training on how to conduct a proper sexual assault forensic medical examination. Live or real-time sexual assault nurse examiner (SANE) consultation provided via telemedicine (known as “teleSANE”) during sexual assault examinations is a promising new practice to address this issue. Purpose The purpose of this study was to assess ED nurses' perceptions of influences on telemedicine use, as well as the utility and feasibility of teleSANE, and identify potential influences on teleSANE implementation in EDs. Methods Guided by the Consolidated Framework for Implementation Research, this developmental evaluation involved semistructured qualitative interviews with 15 ED nurses from 13 EDs. Results Interviews revealed facilitators and barriers to current telemedicine use across Consolidated Framework for Implementation Research levels. Facilitators included state-level grant funding and technical assistance. Barriers included clinician discomfort being on video and access to ongoing training. Participants believed teleSANE consultation would improve patient care and forensic evidence collection but had concerns for patient privacy and acceptability. Most participants worked in EDs that have the information technology support and telemedicine equipment needed to support teleSANE implementation, although many requested ongoing education and trainings on teleSANE and sexual assault care to improve clinician confidence and account for high staff turnover. Discussion Findings highlight the unique needs of sexual assault survivors receiving telemedicine services in EDs, particularly those in rural communities with heightened privacy concerns and limited access to specialty care.

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Do Hospitals Providing Telehealth in Emergency Departments Have Lower Emergency Department Costs?

Cited by 7 publications

References 29 publications

Cost-effectiveness of an Emergency Department–Based Intensive Care Unit

Cost-effectiveness of an Emergency Department–Based Intensive Care Unit

Novas tecnologias e excelência na unidade de emergência

Factors Affecting Telemedicine Implementation in Emergency Departments and Nurses' Perceptions of Virtual Sexual Assault Nurse Examiner Consultation for Sexual Assault Survivors

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