Under the ED TeleTriage model, the physician who used to be stationed near the entrance of the ED for the PIT shift now works from a remote command center—yet remains central to the ED workflow. First, a triage nurse in the ED interviews the patient in-person. Then, the nurse connects to the off-site attending physician via a video connection and summarizes the patient’s symptoms to the physician with the patient present. Meanwhile, the physician in the remote command center looks at computer screens—one displaying a secure, live, two-way video and audio connection, and the other showing the electronic health record (EHR).
After listening to the triage nurse’s summary, reviewing the patient’s EHR, and interacting directly (but virtually) with the patient, the physician institutes a diagnostic and treatment plan with direct order entry. Instead of returning to the waiting room, the patient transitions to the internal area of the ED where labs are drawn, medications are given, and patients are transported to radiology.
This model eliminated some repetitive steps that used to require the patient to speak to the nurse and physician separately. Instead, while all patients still see a provider and receive the usual evaluation and management, this connected step improves efficiency and leads to shorter waits for the patient. Approximately one third of the time, the patient requires no additional diagnostic tests or medications than the ones ordered by the PIT physician, and the primary clinical team can finalize the patient’s ED visit based on the initial interventions.
To date, more than 50,000 patient visits have been recorded using the TeleTriage model. The median wait time between the nurse’s request for a consult and the time the TeleTriage physician sees the patient on the screen is 28 seconds.
Pre-TeleTriage, the maximum workload per PIT shift was 90 patients. Through the new model, that number rose to 137 patients—without using any additional physician resources. The environment is also vastly improved for the physicians: they can sit more, experience less interruptions, and can even use a treadmill desk.
This model has been successful at MedStar Washington Hospital Center and has been piloted in other MedStar hospitals and urgent care centers.
Bloomberg, “How Tech Actually Saves Jobs (Podcast)”
NBC Washington, “Virtual ER Cuts Down on Wait Times at MedStar”
Washington Business Journal, “How one D.C. Hospital cut Down its ER Wait Times, Some of the Longest in the City”
Advisory Board, “How a MedStar Hospital Slashed ED Wait Times by More Than 1 Hour”
American Hospital Association, “Members in Action Case Study: TeleTriage Emergency Department Program, MedStar Washington Hospital Center, Washington, D.C.”