325 Telemedicine Model of Physician Intake Decreases Door-to-Provider Time

Abstract

To reduce delays in patient care, expedite patient flow, and qualify for metrics-based payment bonuses, emergency departments (EDs) have utilized different strategies including physician staffing in the triage and intake process. A telemedicine model of physician-directed intake provides new opportunities for scalability and flexibility in high volume EDs and implementation in lower volume EDs that may not be able to justify a physician in person due to workflow and cost. The study objective was to determine the impact of an innovative telemedicine model of physician directed intake (“tele-intake”) on ED metrics compared with a traditional model of an intake physician physically present in the ED. We performed a retrospective database review of emergency department visits to a large, urban, tertiary care academic hospital in which primarily patients assigned ESI level 2 and 3 were initially evaluated by an intake physician physically present within the department, by a physician via a telemedicine model with remote audio/visual capabilities, or without any physician staffing in the intake process. Our primary outcome was median door-to-provider time, with secondary outcomes of median triage to initial provider time, treating physician time to disposition decision time, and door-to-disposition times. We analyzed a sample of 13,912 emergency department encounters between September 2015 and February 2017, with 7,326 patients evaluated by the traditional in-person physician intake model and 6,586 patients evaluated by the telemedicine intake model. Results for our primary and secondary outcomes are summarized in Table 1. The door-to-provider time was significantly reduced with the tele-intake model compared to the traditional physician intake model (32 minutes vs. 44 minutes, p < 0.001). Total door-to-disposition times were identical in the tele-intake and traditional intake groups (326 minutes). When patients completed the intake process and were then seen by the second physician who would be primarily responsible for the patient’s ongoing treatment, the time to disposition was significantly reduced for both tele-intake and traditional intake groups (116 minutes) compared to when there was no physician in the intake area helping to order diagnostic studies and therapeutic interventions (165 minutes) (p <0.001). In a high volume, high acuity, tertiary care emergency department, a telemedicine model of a physician intake process can positively impact door-to-provider time when compared with traditional physician intake with similar time to disposition decision metrics.