Assessment of a multi-center tele-urgent care program to decrease emergency department referral rates in the Veterans Health Administration.

The use of emergency departments for non-emergent issues has led to overcrowding and decreased the quality of care. Telemedicine may be a mechanism to decrease overutilization of this expensive resource. From April to September 2020, we assessed (a) the impact of a multi-center tele-urgent care program on emergency department referral rates and (b) the proportion of individuals who had a subsequent emergency department visit within 72 h of tele-urgent care evaluation when they were not referred to the emergency department. We then performed a chart review to assess whether patients presented to the emergency department for the same reason as was stated for their tele-urgent care evaluation, whether subsequent hospitalization was needed during that emergency department visit, and whether death occurred. Among the 2510 patients who would have been referred to in-person emergency department care, but instead received tele-urgent care assessment, one in five (21%; n = 533) were subsequently referred to the emergency department. Among those not referred following tele-urgent care, 1 in 10 (11%; n = 162) visited the emergency department within 72 h. Among these 162 individuals, most (91%) returned with the same or similar complaint as what was assessed during their tele-urgent care visit, with one in five requiring hospitalization (19%, n = 31) with one individual (0.01%) dying. In conclusion, tele-urgent care may safely decrease emergency department utilization.

Feasibility of a Telemedicine Urgent Care Program to Address Patient Complaints on First Contact.

Many health systems employ nurse telephone advice services to facilitate remote triage of patients to appropriate level of care. However, the effectiveness of these programs to reduce ED and subsequent health care utilization remains to be demonstrated. We describe a novel virtual urgent care program implemented within a Veterans Affairs (VA) health care system that interfaces with a nurse telephone advice line and leverages telemedicine tools to rapidly address and resolve nonemergent conditions. During a 4-month pilot period, 104 unique patients received care through the program, and over 85% of patients achieved timely resolution for their urgent complaints on first contact with the health care system. Demonstrating feasibility for such a program has potential implications for the optimization of remote triage and urgent care services to improve health care utilization and outcomes.