*updated June 2020
When used for their original intentions, emergency departments provide essential life-saving medical services. However, when patients visit the ER due to lack of access to another provider, this can result in unnecessary, non-urgent emergency room visits—at high costs to patients and providers.
Expediting emergency care with telehealth
With the widespread use of smartphones and laptops, it has become easier for patients to seek medical attention from the comfort of their own homes. Telemedicine technologies can help patients get faster opinions on their health concerns—encouraging them to proceed with further in-person treatment, if needed. A University of Iowa study revealed that rural hospitals using telemedicine in their ERs saw patients six times more quickly than hospitals that did not use such technology.
Several startup companies, such as EmOpti and TeleMedCo, have developed virtual solutions to screen ER patients. These software companies act as telemedicine triage to expedite the more routine aspects of healthcare while increasing physician efficiency and optimizing health outcomes. As technology continues to expand, real-time monitoring with biometric data will lead to an increase in the types of cases that can be addressed remotely.
Beyond tech startups, large health systems are also taking matters into their own hands to improve wait times. To combat their consistently long wait times, NewYork-Presbyterian/Weill Cornell Medical Center (NYPWC) began utilizing telehealth in its emergency department.
All low-acuity patients experience the same onboarding: triage nurses ask for the primary complaint and record patient vitals, and a nurse practitioner (NP) or physician assistant (PA) examines the patient to assess stability. If a patient is deemed to be in stable condition, they are eligible for the hospital’s express service. Express patients are then sent to their own room where they have a video conference with affiliated physicians in other areas of the NYPWC health system.
Since the express telehealth service was launched in July 2016, NYPWC has continuously expanded their virtual care delivery by launching the Hauser Institute for Health Innovation in 2019. This institute has a specific focus on remote patient monitoring and teleparamedics with an overarching goal of providing high-quality, convenient, and affordable care with an emphasis on preventive health and wellness.
Top 10 hospitals with longest average ER wait times
||Avg Wait Time (Minutes)
||Santa Cruz Valley Regional Hospital
||Manati Medical Center
||Doctors Center Hospital Bayamon
||Ben Taub Hospital
||Northeastern Vermont Regional Hospital
||Beth Israel Deaconess Medical Center
||UC San Diego Medical Center - Hillcrest
||Sage Memorial Hospital
||Doctors Center Hospital Miami
Fig 1 Data from Definitive Healthcare's Hospitals & IDNs database using the Quality Metrics Search. Data collection period spanned from July 1, 2018 to June 30, 2019, and was released in April 2020. Numbers reflect the rate of the average (median) number of minutes patients spent in the emergency department before being discharged. Data accessed June 2020.
Longer emergency department wait times contribute to overcrowding and delays in medication administration for patients with mid-level injuries and illnesses (like broken bones and infections) as well as greater risk of patient exposure to medical error. Patient mortality rate is also higher with longer wait times, though usually only by a small margin and for patients older than 80.
Despite these figures, the most recent report available from the Centers for Disease Control and Prevention (CDC) reports only 39 percent of R visits resulted in a patient being seen in fewer than 15 minutes.
With the help of telemedicine intervention, emergency room visits could possibly be if low-acuity are able to speak to a physician over the phone before deciding how to . According to a study published in the Journal of Telemedicine and Telecare, telemedicine in a pre-hospital environment resulted in a 6.7 percent reduction in medically unnecessary ER visits.
Top 10 hospitals with longest ER wait times
||Avg Wait Time (Minutes)
||Clovis Community Medical Center
||Harney District Hospital
||Community Regional Medical Center
||University of Puerto Rico Hospital
||Mayaguez Medical Center
||Loma Linda University Medical Center
||UK Albert B Chandler Hospital
||George Washington University Hospital
Fig 2 Data from Definitive Healthcare's Hospitals & IDNs database using the Quality Metrics Search. Data collection period spanned from July 1, 2018 to June 30, 2019, and was released in April 2020. Numbers reflect the rate of the average (median) number of minutes patients spent in the emergency department before being admitted to the hospital. Data accessed June 2020.
How can hospitals reduce ER overcrowding?
Patient education is one of the simpler solutions to ER overcrowding. A study from UC San Francisco (UCSF) found that nearly 3.3 percent of all ER visits in a seven-year period led to patients being sent home without any administered care. By volume, that means nearly 14 million patients visited the ER unnecessarily—clogging care access for more high-risk or high-acuity patients.
Many of the visits recorded in the study were non-emergency complaints like toothaches, back pain, headaches, throat soreness, and psychosis-related issues. Emergency departments are designed to care for patients with life- or limb-threatening issues, not specialty care. But some patients might not know where else they should go.
For patients, it can be difficult to determine whether they should visit the ER, an urgent care clinic, or make an appointment with a primary care physician. While ERs are intended for imminent danger, urgent care clinics are better equipped to handle fevers, sore throats, sprains, fractures, and other immediate—but not life-threatening—health concerns.
Top 10 hospital ERs with highest percentage of patients who left before being treated
||Percentage of Patients
||Washington County Regional Medical Center
||Capital Medical Center
||SSM Health St Marys Hospital - St Louis
||Southern Regional Medical Center
||University of Maryland Medical Center
||Jefferson County Hospital
||NYC Health and Hospitals- Lincoln
||Roseland Community Hospital
||St Francis Hospital
Fig 3 Data from Definitive Healthcare's Hospitals & IDNs database using the Quality Metrics Search. Data collection period spanned from January 1, 2018 to December 31, 2018, and was released in April 2020. Numbers reflect the percentage of patients who left the emergency department before being seen by a physician. Data accessed June 2020.
In some areas of the U.S., patients may visit the ER because they have few or no other choices. In rural areas, patients visit emergency departments between 60 and 80 times per year. For those with chronic pain, an ER may be the only place to get relatively fast relief, especially if their primary care physician isn’t knowledgeable about their particular illness. This new insight into “high-utilizers” and avoidable ER visits has alerted care providers to a lack of patient services—particularly surrounding mental health, dental care, and specialty services.
Learn more: 2020 healthcare trends
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