295 The Impact on Emergency Department Visits With a Telemedicine Program Interfacing With a Nurse Triage Call Line

Abstract

Nurse triage phone lines (RNTL) are not a novel concept for health care organizations. They exist in many countries (United Kingdom, Australia, Sweden, Denmark, and Canada) as government-sponsored national triage systems; as well as in the United States where there a many smaller systems within various health care organizations. Patients calling the RNTL receive assessment and advice over the telephone regarding their medical symptoms. RNTLs may recommend follow-up with a Primary Care Provider (PCP), suggest home cares, or advice to proceed to an emergency department (ED) for immediate evaluation. Phone triage systems appear to be safe and patient satisfaction is generally high. Historically, studies looking at the effect of the availability of phone triage lines on health care utilization have shown mixed results. RNTLs often follow conservative protocols when providing a disposition for the patients they counsel. EDs often see patients when directed by the RNTL when outpatient management might be more appropriate. We aim to describe a novel intervention and outcomes using an emergency telemedicine (TeleEM) program to provide disposition when an RNTL suggests a patient should go to the ED. A prospective, observational pilot over 3 separate weeks where the RNTL would contact the on duty TeleEM physician if their algorithm suggested a patient present to an ED or an urgent care (UC). The physician would discuss the case with the RNTL, or in cases of ambiguity, discuss with the patient directly. For each encounter, we collected: basic patient demographics (age and sex); original RNTL disposition; TeleEM MD disposition; if a patient presented to an ED within 24 hours; if a patient presented to an ED > 24 hours or < 7 days; disposition of patients who presented to an ED. We excluded any calls the RNTL felt needed a 911 response or could be seen in a clinic. The Mayo Clinic institutional review board approved of the study. There were 155 distinct calls for analysis. Mean age (years) = 42.5 (SD 28.1). 62% female. 57% (n=89) of the RNTL calls recommended an ED evaluation with 20% (n=31) due to lack of clinic access, leaving 43% (n=66) recommended to seek urgent care. Of the 89 RNTL ED dispositions, TeleEM physicians recommended the following: ED: 61% (n=54); UC: 6% (n=5); Clinic: 26% (n=23); Home Care: 8% (n=7) Of the 35 patients without an ED disposition by the TeleEM provider: 8 (23%) presented to an ED within 24 hours resulting in 1 (3%) admission and 7 (20%) discharges 3 (9%) presented to an ED > 24 hours resulting in 2 (6%) admissions and 1 (3%) discharge Of the 66 RNTL UC dispositions, TeleEM physicians recommended the following: ED: 24% (n=16); UC: 30% (n=20); Clinic: 29% (n=19); Home Care: 17% (n=11) Of the 50 patients without an ED disposition by the TeleEM provider: 4 (8%) presented to an ED within 24 hours resulting in 1 (2%) admission and 3 discharges 2 (4%) presented to an ED > 24 hours resulting in 0 (0%) admissions and 2 discharges. Our TeleEM program was successful in aiding our RNTL with dispositions and mitigating ED use. Overall, patients when directed away from the ED by the TeleEM physician, few presented to an ED with even fewer requiring admission. We feel this demonstrates a safe practice and we plan to further prospectively study this novel intervention. We hope these data will be used to show value to payers in environments where ED utilization is high and in the future offset climbing ED volumes, while improving patient phone triage quality.