Clinical Services

Ignite Sessions

CS2-02 - Express Care, a Novel Role for ED Doctors Deployed to Telemedicine

Sunday, April 29
1:25 PM - 1:34 PM
Location: Innovation Zone, Booth 434

We have initiated a telemedicine program where Weill Cornell physicians dedicated to telehealth roles see direct to consumer patients, assist in triage, answer telemedicine calls from a local nursing home. These telehealth roles have been described in several different venues; we have consolidated them into one provider preforming a telehealth shift. In addition to these roles we also have patients care for low acuity patients who are physically in our two emergency departments; we call this novel service "Express Care".
Patients are eligible for an Express Care visit if they present to our ambulatory triage with low acuity Emergency Severity Index (ESI) scores and are deemed by the greeter RN unlikely to require significant ED resources. Patients are seen by a physician assistant or nurse practitioner. After this medical screening they are evaluated by the telehealth attending. The physicians who care for patients by telehealth are all part of our medical school faculty who do regular emergency department work. Each is board certified in Emergency Medicine and has greater than 5 years of post-residency clinical experience. The physician does a video exam and as needed may call in prescriptions, order ED medications or x-rays, and arrange for follow up care. The Express Care physician reviews discharge and follow up recommendations and directly discharges the patient, providing them with discharge instructions printed to the patient's room.
Since ECS was launched in July 2016, we have seen more than 3,000 patients with a typical length of stay of 35 to 40 minutes - as compared to an average of 2 to 2.5 hours' stay in the ED for patients seen in person via the traditional ED pathway. These improvements in operational metrics have occurred because the implementation of ECS has allowed us to streamline care by reducing workflow interruptions and delays. The diversion of lower-acuity patients to ECS enables providers and staff in the main ED to focus their attention on patients with more emergent medical conditions, thereby making the care of these patients more efficient. The involvement of the telemedicine doctor in these evaluations helps make the financial case for maintaining a dedicated telehealth position.
Patient satisfaction scores for ECS have been outstanding, ranking in the 99th percentile. Our physicians have also indicated that they enjoy providing this virtual care. As part of our ongoing quality assurance program, we monitor 72-hour ED revisit rates for our ECS patients. Currently, the number of ECS patients who revisit the ED within 72 hours of their virtual visit is less than 3%, which is lower than the 3.5% to 7.5% that has been reported for ED patients in traditional settings, When we account for revisits that were part of the initial treatment plan, the revisit rate is less than 2%. The majority of these unplanned returns do not result in any change in treatment. Even more impressively, to date none of these ECS 72-hour return visit patients have required an admission for inpatient hospitalization.

Learning Objectives:

Peter Greenwald

Director ED Telehelath QA
Weill Cornell Medical College

Dr. Peter Greenwald is a Board Certified Emergency Medicine Physician. He is a graduate of SUNY Downstate Health Science Center Brooklyn, completed his residency at the Albert Einstein College of Medicine/Jacobi Medical Center and has received a masters degree in biostatistics and research design from the Mailman School of Public Health. Dr Greenwald is the Emergency Medicine Telehealth Services Co-Director and Director of Emergency Medicine Telehealth Quality Assurance at Weill Cornell.

Presentation(s):

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