Catalyze Innovation that Advances Health

MedStar Health Emergency Department (ED) TeleTriage Program

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Summary

The team developed a virtual triage program for faster emergency care.

Team

MedStar Telehealth Innovation Center

Background

Located in the heart of the nation’s capital, MedStar Washington Hospital Center is among the 100 largest hospitals in the nation, receiving more than 88,000 total Emergency Department (ED) visits in a year. As with many other urban EDs, overcrowding and complicated care can lead to long patient wait times. 

In response, the hospital successfully implemented an in-person provider-in-triage (PIT) program. This essentially stationed a physician to assist patients right after they entered the ED from the waiting room. It reduced “door-to-doctor time,” the number of patients leaving the ED without being seen, and the wait time for medications. The PIT shift could be especially tough for the physician, however, who saw up to 90 patients and was stationed in a location prone to interruptions despite it being convenient for workflow. 

In 2015, the MedStar Institute for Innovation (MI2) and MedStar Emergency Physicians recognized an opportunity to leverage telehealth advancements to evolve, modernize, and further enhance the already successful PIT program. They partnered with a startup company to consider how workflow improvements and telehealth technology could provide faster emergency care and improve both the patient and clinician experience. They piloted what has since become the MedStar Health Emergency Department (ED) TeleTriage Program, starting at MedStar Washington Hospital Center.

Idea

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.

Impact

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.