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Pilot Program Uses Telemedicine to Reduce Emergency Room Wait Times

Cameras bring on-call docs to patients in need (June 11)

Emergency department (ED) overcrowding has been a major issue nationally for 20 years and continues to increase in severity. To address this issue, a pilot study has been launched at the University of California–San Diego Health System’s ED to use telemedicine as a way to help address crowding and to decrease patient wait times. The study is the first of its kind in California to use cameras to bring on-call doctors who are outside of the hospital to the patient in need.

“This telemedicine study will determine if we can decrease wait times while reducing the number of patients who leave the ED without being seen by a physician,” said principal investigator David Guss, MD. “With the ED physicians on site and an added telemedicine physician, patient care may be significantly expedited. If the use of a telemedicine evaluation can be shown to be safe and effective, it may shift how care in the emergency department is delivered.”

The study, called the Emergency Department Telemedicine Initiative to Rapidly Accommodate in Times of Emergency (EDTITRATE), brings telemedicine doctors to patients when the ED becomes busy. An offsite doctor is paged, and he or she then remotely links to a telemedicine station to see patients. With the aid of an ED nurse, these patients are seen based on arrival time and on the level of medical need.

Guided by high-fidelity sound and video, the telemedicine physician can examine a patient’s eyes, ears, nose, throat, and skin, as well as listen to heart and lung sounds through the module. Laboratory and imaging tests can be ordered and results reviewed. Physician ordering and documentation is accomplished through an electronic medical record. As a final step, the onsite attending physician reassesses the patient to confirm the findings and actions, as well as to address any unanswered questions from the patient.

“Working in an emergency department open around the clock, you never know who may come through the door, so you are constantly faced with the challenge of matching staffing resources with the demands for care,” said Guss. “Some emergency departments have placed a physician in the triage area to expedite care; however, if there is low demand for service during these times, an underutilized physician creates an unneeded expense.”

To add to the challenge, when an on-call physician is needed to augment provider resource, there can be delays in making the call or a significant delay until the physician arrives. With a telemedicine physician, the wait is just minutes.

Source: University of California–San Diego; June 11, 2013.

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