The ED Epidemic (and what to do about it)
Nationwide, the epidemic of Emergency Departments (Emergency Rooms) being used as “primary care” by patients who don’t necessarily require emergency care has been on the increase for years. Although it varies from state to state, there are a number of variables that contribute to these occurrences. However, in all cases, an over-crowded ED can translate into ED physicians becoming a more limited resource. It goes without saying that any patient seeking care for a non-emergent event potentially procures the physicians’ time away from patients with potentially life-threatening conditions.
Estimates vary in regards to the percentages of ED patients who actually need emergent care, with some rates as low as 30%. The trend isn’t decreasing any time soon. In fact, healthcare systems such as Scripps Health Network (San Diego) have seen up to a 160% increase in the number of emergency room visits for non-emergent care in a single year.
“Something must be done--and soon--because what's happening in California ERs is a public health crisis, and it's happening now." – Chris Van Gorder, CEO, Scripps Health
Van Gorder suggests that telemedicine can play a key role in reducing ED overcrowding by encouraging preventative care for the elderly. In some areas, elderly populations may not seek preventative care due to access limitations and/or logistical issues involved in seeing a physician. A recent study supports his theory.
“A three-and-a-half year study concludes that the use of “high-intensity” telemedicine at senior-living communities significantly reduces visits to emergency departments (ED).
Acute illness among senior-living community residents often leads to emergency department visits,” said Dr. Manish Shah, vice chair of research in the department of emergency medicine at the UW School of Medicine and Public Health. “We found that these virtual doctors’ visits reduced the rate of emergency department use by 18 percent over the course of a year.”
Technology can certainly play a key role in the resolution of “ED overcrowding” by not only being used as a preventative measure, but also if it utilized at the point of care during the triage process.
New York Presbyterian’s Health System is an 11-facility network and is now utilizing a telemedicine platform called NYP OnDemand. Early returns indicate that this platform is dramatically reducing patient wait-times for patients with non-life threatening and non-emergent conditions. The process is fairly straight-forward. Patients checking into the ED for non-emergent or non-life threatening conditions have the opportunity to go into a designated room and speak to a physician via a telemedicine application. The physician is housed in another room within the facility, but has the ability to serve multiple telemedicine exam rooms. This application also allows for these physicians to serve and triage urgent care patients in remote locations (home, etc.). Each visit (telemedicine exam) is approximately 30 minutes (depending upon the patient’s condition) and helps reduce the number of non-emergent patients in the ED. This not only assists with staffing efficiency, but also helps ED physicians focus more effectively on the higher acuity patients.
“It’s all about delivering care more efficiently”, said Daniel Barchi, the system’s chief information officer. “If we can create an environment where a virtual visit allows that doctor to see many patients in a really efficient model, that’s the ultimate goal,” he said.
Thus, telemedicine technology applications play a key role in facilitating greater access to preventative care and more efficient treatment of non-life threatening conditions in ED and urgent care settings. “I’ve got a fever, and the only prescription, is more telemedicine.”
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