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April 11, 2017

How this NY hospital cut non-urgent ED wait times by nearly two hours

Daily Briefing

    A new telemedicine program at NewYork-Presbyterian/Weill Cornell Medicine has helped the hospital cut down on patient wait times in the emergency department—and other hospitals are taking notice, Sumathi Reddy reports for the Wall Street Journal.

     According to the Journal, the attention of other hospitals and health systems suggests that the program could be implemented elsewhere as telemedicine services continue to grow in popularity.

    How the program works

    Weil Cornell's Express Care telemedicine program aims to move non-urgent cases through the ED quickly without compromising care, the Journal reports. 

    All ED patients at Weil Cornell receive standard in-person triage, which involves an assessment by a nurse practitioner  or physician assistant. If the clinician determines that a patient's symptoms are not life-threatening, clinicians give the patient the option of using the Express Care program.

    Patients who opt for the telemedicine program meet with an ED physician via videoconferencing in a private room. Usually, a physician assistant or nurse practitioner is present with the patient to help with procedures, such as stitches or ordering medical tests. Weil Cornell bills the visits as a standard ED visit because patients receive a full triage and medical screening, according to Rahul Sharma, the emergency physician-in-chief at Weill Cornell.

    According to the Journal, about 30 percent of patients who use the telemedicine program receive routine procedures, such as wound checks, or suture removals. Other medical issues commonly addressed through the program include contusions, eye pain, rashes, and respiratory infections.


    According to the Journal, Weil Cornell has conducted more than 1,700 visits through the program since it launched in July 2016.

    Sharma said patients who used the Express Care program typically spend an average of 35 to 40 minutes in the ED, compared with an average of two to 2.5 hours for patients who do not use the program.

    Further, Express Care allows physicians who see patients via the program to more quickly shift between seeing patients and completing administrative tasks, the Journal reports.


    Weil Cornell plans to expand the program, and other providers could follow suit, the Journal reports. More than a dozen hospitals and health systems have reached out to Sharma to learn about the program, according to the Journal.

    John Deledda, chair of emergency medicine for the Henry Ford Health System, called the approach "very novel" and "frankly not too complex." He said, "Because of that, I think it's very applicable for most academic, urban medical centers that are handling a lot of subacute and minor types of complaints that are traditionally handled outside of the [ED] by primary-care doctors."

    Ali Raja, vice chair of the department of emergency medicine at Massachusetts General Hospital, said, "Ten years from now, tele-emergency medicine will be the standard around the country."

    However, critics of telemedicine have questioned whether the practice compromises quality of care and makes care impersonal. But emergency medicine experts have said that such issues are not relevant to the in-house ED approach because patients still have access to the hospital and are being assisted by a physician assistant or nurse practitioner. In addition, Sharma said video conferencing with a physician in a private room, for some patients, could be more intimate than talking to a provider in a hectic ED (Reddy, Wall Street Journal, 3/27).

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