ATA2023Annual Conference & ExpoMarch 4–6, 2023San Antonio, Texas

Abstract

Telemedicine and e-HealthVol. 29, No. 4 AbstractsFree AccessATA2023Annual Conference & ExpoMarch 4–6, 2023San Antonio, TexasPublished Online:4 Apr 2023https://doi.org/10.1089/tmj.2023.29089.abstractsAboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail “In support of improving patient care, this activity has been planned and implemented by the Renal Physicians Association and the University of Virginia School of Medicine and School of Nursing is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.”AMA PRA CATEGORY 1 CREDITThe University of Virginia School of Medicine and School of Nursing designates this live virtual activity and enduring material, for a maximum of 26.0AMA PRA Category 1 Credits.TM Physicians should claim only the credit commensurate with the extent of their participation in the activity.ANCC CONTACT HOURSThe University of Virginia School of Medicine and School of Nursing awards 26.0 contact hours for nurses who participate in this educational activity and complete the post activity evaluation.MOC IISuccessful completion of this CME activity enables the participant to earn MOC points equivalent to the amount of CME credits claimed for the activity for a maximum of 26.0 MOC Part II (ABMS) points.“Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 26.0 MOC points [and patient safety MOC credit] in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.”.ATA2023 – Research AbstractsOral PresentationsO‐1. A VIRTUAL INTEGRATED CARE PROGRAM IMPROVES PATIENT OUTCOMES, ENGAGEMENT, AND SATISFACTION AT REDUCED COSTS: A PROSPECTIVE TRIALSameer Berry, MD, MBA, 1 Jeffrey Berinstein, MD, MS,2 David Cook, MD, MHA,3 Michael Lahm, MS, OptumLabs,3 Walter Chan, MD, MPH, 4 John Allen, MD, MBA, 5 William Chey, MD51Oshi Health, New York Gastroenterology Associates2Division of Gastroenterology, Department of Internal Medicine, University of Michigan School of Medicine3OptumLabs4Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital; Harvard Medical School5Division of Gastroenterology, Department of Internal Medicine, University of Michigan School of MedicineDescription: We evaluated the efficacy of a virtual integrated care program among 234 patients with functional gastrointestinal disorders. Enrolled patients demonstrated fewer missed work days, reported improvement in work productivity, and high program engagement, satisfaction, and symptom improvement with significant savings in healthcare costs compared to matched controls.Abstract: Functional gastrointestinal disorders (FGIDs) are common conditions characterized by chronic gastrointestinal (GI) symptoms without structural abnormalities. FGIDs are complex and may benefit from a virtual integrated‐care approach. We performed a prospective, single‐arm clinical trial with propensity‐score matched controls to evaluate the efficacy of a virtual integrated‐care program for patients with FGIDs and impact on outcomes, satisfaction, and costs. Analyses using two index events (GI_Visit_+Lookback and GI_Visit) compared differences when including upstream costs prior to the GI visit in the matched control group. 234 participants enrolled with 83% patient engagement, 98% satisfaction, and 92% symptom improvement. Participants reported fewer missed workdays and demonstrated lower healthcare utilization. After 6 months, patients in the virtual integrated‐care program had significantly lower GI‐related costs compared to the control group in both GI_Visit_+Lookback ($3,934 vs. $9,047, p < 0.0001) and GI_Visit ($3,674 vs. $5,996, p = 0.0026) analyses. Difference‐in‐difference analysis after 6‐months demonstrated lower GI‐related costs in the virtual program of $6,724 (GI_Visit_+Lookback, p < 0.0001) and $3,095 (GI_Visit, p = 0.0039). A virtual integrated program resulted in high patient engagement, satisfaction, and symptom improvement with significantly reduced healthcare utilization and costs compared to matched controls.Classification of Research: Access to CareMethod: Single‐arm clinical trial with propensity score matched observational controlsResults: 234 participants enrolled with 83% patient engagement, 98% satisfaction, and 92% symptom improvement. Participants reported fewer missed workdays and demonstrated lower healthcare utilization. After 6 months, patients in the virtual integrated‐care program had significantly lower GI‐related costs compared to the control group with both the GI_Visit_+Lookback ($3,934 vs. $9,047, p < 0.0001) and GI_Visitanalyses ($3,674 vs. $5,996, p = 0.0026). Difference‐in‐difference analysis after 6‐months demonstrated lower GI‐related costs in the virtual program of $6,724 (GI_Visit_+Lookback, p < 0.0001) and $3,095 (GI_Visit, p = 0.0039).Conclusions: A virtual integrated care program resulted in high patient engagement, satisfaction, symptom improvement, reduced healthcare utilization, and statistically significant cost‐savings compared to matched controls. Traditional care is often unable to address the needs of patients with functional gastrointestinal disorders resulting in poor outcomes, unnecessary cost, and tremendous patient suffering. This virtual integrated care program represents a high‐value intervention for patients with complex chronic gastrointestinal conditions refractory to traditional care models.Grant Support: ADAPT UCSF.O‐2. AN APPROACH TO EFFECTIVE PATIENT AND PROVIDER ENGAGEMENT STRATEGIES IN A VIRTUAL PHARMACIST CLINICTram Thai, PharmD, 1 BCACP, AE‐C, Greg Downing, DO, PhD, 1 Melanie Plotke, 1 Eric Olmsted, 2 Farrukh Jafri, MD, 31Cureatr2CWH Advisors3White Plains HospitalDescription: An efficacy study to assess an innovative care model in a Virtual Pharmacist Clinic to optimize medication management and increase patient‐provider engagement by facilitating multiple points of contact and leveraging multiple communication channels. The goals of this quality improvement program were to decrease hospital readmissions and improve patient satisfaction.Abstract: Patient‐provider telehealth engagement is critical to impacting outcomes with optimal cost‐effective strategies still under investigation. Interactions made by clinical pharmacists and clinical support staff with post‐discharge adult patients transitioning home across one hospital and two health plans were studied in this retrospective analysis over the period of 8 months. Process of interest included strategies for: (1) patient outreach, (2) provider uptake of recommendations, and (3) patient satisfaction. First steps included scheduling patients for an appointment with a clinical pharmacist by contacting the patient via phone, SMS, and email for days 1‐10 post‐discharge utilizing the enrollment attempt process outlined in Figure 1. During the patient visit, clinical pharmacists completed a full medication review, including disease state and medication education, addressing barriers to access of medications, and managing patient questions or concerns. Medication optimization recommendations and safety threats were relayed to the patient's provider at the conclusion of the visit by fax, and by phone for urgent concerns at risk of readmission or adverse event that could lead to harm. Patients were asked to complete an optional 3‐question satisfaction survey regarding their visit with the clinical pharmacist scoring on a scale of strongly agree (1) to strongly disagree (4).Classification of Research: Quality ImprovementMethod: DescriptiveResults: A 6.9% decrease in 30‐day heart failure readmissions was observed in the health system group. Uptake of recommendations across all groups ranged from 58% to 81%, noting increased uptake with medication access interventions. Of 13,933 eligible patients, 6,843 (49.1%) patients scheduled a visit, with higher success secondary to reaching the patient within 72 hours post‐discharge. A total of 20.6% of patients completed the optional patient satisfaction survey, averaging 1.1 for satisfaction with care received, 1.2 for the ability to ask questions, and 1.2 for having a clear understanding of their medication purposes.Conclusions: In our descriptive review, higher patient engagement was associated with contact within 72 hours post‐discharge. Provider engagement was found to be higher for concerns regarding access to medications. The impact of this virtual model led to a statistically significant reduction in 30‐day readmission for heart failure patients along with positive satisfaction scores among those who received care from the virtual pharmacy clinic.O‐3. ASSESSING THE VALUE PROPOSITION OF VIRTUAL CLINICAL CARE DELIVERY PROGRAMS FROM DISCOVERY THROUGH IMPLEMENTATION AT MAYO CLINICLaura Christopherson, Ed.D. MBA, Angela Leuenb, MSMayo ClinicDescription: The value proposition should be considered when evaluating new virtual clinical care delivery programs. The overall assessment of the value proposition begins at discovery and informs the decision to proceed with program development. Once developed, an assessment plan should be utilized to measure program effectiveness against baselines and targets.Abstract: We took a systematic approach to assess the value proposition of virtual clinical programs across the care continuum including low‐intensity and high‐intensity programs designed to monitor patient's biometric data and symptom assessments. This included remote patient monitoring programs and app‐based interactive care plans that utilize technology to monitor patients remotely, keeping them in their homes and engaged in managing their condition or health event. A framework was developed that considered the desirability, viability, and feasibility of each new program request. The framework requires input of the patient population volume, clinical goals, predicted clinical outcomes, impact on care team burden, cost of development, and patient and provider satisfaction targets. A multi‐disciplinary team of providers, nurses, operational leaders, and implementation scientists developed the inputs for this framework. The inputs were then scored to enable prioritization of program development based on anticipated impact for patients and care teams. This evaluation process ensured that programs with the highest potential for achieving clinical goals are prioritized while balancing costs and care team satisfaction. As plans were being designed, an assessment plan was developed to establish baselines and targets post‐implementation. This plan was deployed to gather data and develop reporting solutions to enable program evaluation post‐implementation.Classification of Research: Measurement Frameworks & ToolsMethod: DescriptiveResults: The assessment framework was developed and utilized across all virtual clinical care delivery programs from the discovery phase to program assessment post‐implementation. The discovery teams found that the framework enabled a more robust discovery process that promoted objective evaluation of new programs. The use of the framework strengthened the prioritization process to ensure that program development aligned with institutional priorities across the medical practice. Further, it fostered confidence amongst executive and physician leadership in the development and assessment of new programs, enabling the acceleration of virtual clinical care delivery across the institution.Conclusions: The implementation of the framework enables prioritization of programs that have the highest potential to impact clinical outcomes, enable care team efficiencies and drive costs down. This framework provides utility for clinical and operational teams to evaluate new programs across both the care continuum and the development cycle. In practice, the framework is continually evolving as clinical and operational teams gain a deeper understanding of what measures drive the efficacy of virtual clinical care delivery programs to deliver maximum value to the patients and care teams.O‐4. BUILDING AND SUSTAINING A STATEWIDE TELEPSYCHIATRY NETWORK‐ A DECADE LONG EXPERIENCE OF THE NORTH CAROLINA STATEWIDE TELEPSYCHIATRY PROGRAM (NC‐STEP)Sy Saeed, MD, MSThe North Carolina Statewide Telepsychiatry Program (NC‐STEP), East Carolina UniversityDescription: We will present research findings on ED boarding of patients; cost savings associated with the use of telepsychiatry; and how the COVID‐19 crisis has led a heightened demand for telepsychiatry consultations in NC, but there is a possible race disparity in these demands between black and white mental health patients.Abstract: A growing body of literature now suggests that the use of telepsychiatry to provide mental health care has the potential to mitigate the workforce shortage that directly affects access to care, especially in remote and underserved areas.The North Carolina Statewide Telepsychiatry Program (NC‐STeP) was developed in response to NC Session Law 2013‐360 and launched in October 2013. Since then, as of March 31, 2022, NC‐STeP has provided 52,764 telepsychiatry consults with 8,392 involuntary commitments being overturned, with associated savings of more than $45,316,800. Given the success of the program, in 2018 the North Carolina legislature expanded the scope of services provided to beyond emergency departments to the community‐based settings, using a collaborative care model. Since then, NC‐STeP has added 18 outpatient sites to its 40‐hospital network. We will present data from NC‐STeP published research that focuses on ED boarding of patients; cost savings associated with the use of telepsychiatry; and how the COVID‐19 crisis has led to a heightening demand for telepsychiatry consultations in NC, but there is a possible race disparity in these demands between black and white mental health patients. We will also discuss technological innovations from the program, including developing a web portal.Classification of Research: Regulatory & Policy ResearchClassification of Research ‐ Other (if different from options above): Findings in the areas of clinical outcomes, cost analysis, and access to care‐ all have implications for policy and regulationsMethod: Descriptive. We will present findings from three different studies, including various methodologies.Results: 1. Use of telepsychiatry can enhance patient and clinician experience; and reduce costs by impacting ED boarding time and reducing unnecessary psychiatric hospitalizations.2. COVID‐19 has heightened demand for telepsychiatry consultations in NC, but there is a possible race disparity in these demands between black and white mental health patients.Conclusions: 1. Use of telepsychiatry can enhance patient and clinician experience; and reduce costs by impacting ED boarding time and reducing unnecessary psychiatric hospitalizations.2. COVID‐19 has heightened demand for telepsychiatry consultations in NC, but there is a possible race disparity in these demands between black and white mental health patients.O‐5. CHANGE IN PATIENT RISK FACTORS, PROTECTIVE FACTORS, AND SUBSTANCE USE BEFORE AND AFTER INITIATION OF TELEHEALTH TREATMENT FOR OPIOID USE DISORDER(Presentation combined with The Role of Tele‐OUD Treatment in Decreasing Healthcare Utilization)Barbara Burke, MPH, Winifred Gallogly, BS, Brian Clear, MD, FASAM, Rebekah Rollston, MD, MPHBicycle HealthDescription: An observational study was conducted to compare patient relapse risk factors, protective factors, and substance use prior to and 1 month after initiating tele‐OUD treatment. Two‐hundred seven patients completed a baseline and month 1 Brief Addiction Monitor (BAM). Preliminary results show more favorable scores at month 1 compared to baseline.Abstract: The Brief Addiction Monitor (BAM) is used to monitor drug and alcohol use, relapse risk, and protective factors among patients in treatment for substance use disorders. The objective of this study is to assess how usage, risk factors, and protective factors changed over time after initiation of telehealth treatment for opioid use disorder (OUD). Two‐hundred seven patients completed a baseline and month 1 BAM survey via a mobile application as part of routine care. Preliminary results show that tele‐OUD treatment is associated with less usage of drugs and alcohol, fewer risk factors, and a lower risk‐to‐protective factor ratio.Classification of Research: Clinical OutcomesMethod: ObservationalResults: There were 207 patients who completed baseline and month 1 BAM surveys. The average subscore changes from baseline to month 1 are: 1) usage of drugs and alcohol decreased by 1.6 points out of 12 possible, 2) risk score decreased by 3.2 points out of 24 possible, and 3) protective score increased by 0.4 points out of 16 possible. The average risk‐to‐protective ratio at baseline was 0.77, and at month 1 was 0.51. While both of these ratios indicate more protection than risk, a decrease in ratio at month 1 indicates less risk for use.Conclusions: Exposure to tele‐OUD treatment helps to reduce patient risks for relapse and usage of drugs and alcohol. The results demonstrate that tele‐OUD treatment is associated with less patient‐reported use of drugs and alcohol, fewer triggers or causes of substance use (risk factors), and a lower risk‐to‐protective factor ratio.O‐6. COMPARISON OF QUALITY PERFORMANCE MEASURES FOR PATIENTS RECEIVING IN‐PERSON VS TELEMEDICINE PRIMARY CARE IN A LARGE INTEGRATED HEALTH SYSTEMDerek Baughman, MD,1,2 Yalda Jabbarpour, MD,2 John Westfall, MD, MPH21WellSpan Health2Robert Graham CenterDescription: In this cohort study of 526,874 patients, telemedicine exposure was associated with significantly better performance or no difference in 13 of 16 quality performance comparisons. Findings suggest that telemedicine exposure poses a low risk for negatively affecting HEDIS performance, highlighting its potential to suitably augment care capacity.Abstract: BACKGROUND: It is unknown how the pandemic‐driven rapid adoption of telemedicine has affected quality of patient care.METHODS: HEDIS quality measures were retrospectively compared between patients with office‐only (in‐person) vs telemedicine visits (telemedicine‐exposed) from March 1, 2020, to November 30, 2021, across 200+ outpatient sites in Pennsylvania and Maryland. χ2 tests determined statistically significant differences in quality performance. Multivariable logistic regression controlled for sociodemographic factors and comorbidities.CONCLUSIONS: Patients with telemedicine exposure had a largely favorable association with quality of primary care. This supports telemedicine's value potential for augmenting care capacity, especially in chronic disease management and preventive care.Classification of Research: Clinical EffectivenessMethod: DescriptiveResults: The study included 526,874 patients (409,732 office‐only; 117,142 telemedicine‐exposed) with comparable demographics. Patients with office‐only visits performed better in medication‐based measures, but only 3 of 5 had significant differences: cardiovascular disease (CVD) receiving antiplatelets, CVD receiving statins, and avoiding antibiotics for in URIs (insignificant differences: heart failure receiving β‐blockers and diabetes receiving statins). Patients with telemedicine exposure had better performance in all testing‐based measures (CVD with lipid panels, diabetes with HbA1c testing and nephropathy testing, and blood pressure control) and all counseling‐based measures (cervical, breast, and colon, cancer screening; tobacco and vaccination counseling for influenza and pneumococcus; and depression screening).Conclusions: This cohort study found early evidence of telemedicine's favorable association with the quality of primary care during COVID‐19. For chronic disease management and preventive care, telemedicine exposure appeared to have had a positive association with HEDIS quality performance, and this study highlights a gap in the literature: understanding the relationship between the ideal blend of telemedicine and in‐office care. For policy makers, these findings of comparable quality support telemedicine's continued funding. For practices and health systems, this study demonstrates telemedicine's value in appropriate populations: augmenting primary care capacity without negatively affecting care quality.O‐7. COVID‐19 TELEHEALTH SERVICE CAN INCREASE ACCESS TO THE HEALTHCARE SYSTEM AND BECOME A COST‐SAVING STRATEGY(Presentation combined with Synchronous Teleconsultation and Monitoring Service Targeting COVID‐19: Leveraging Insights for Healthcare).Clara Oliveira, MD, MSc, PhDUniversidade Federal de Minas GeraisDescription: Data addressing the costs and the potential incremental access to healthcare service achieved by the establishment of a COVID‐19 teleconsultation service are incipient. We described the labor costs for running a public COVID‐19 teleconsultation service and the incremental access to healthcare allowed by the establishment of this service in Brazil.Abstract: This study aimed to evaluate the labor costs for running a COVID‐19 telehealth system and its potential incremental access to healthcare service.From July 2020 to July 2021, data from a public Brazilian teleconsultation service were analyzed. Labor costs were estimated by time‐driven activity‐based costing. A Generalized Reduced Gradient solving method was coded to maximize the mean incremental access rate and two scenarios were considered to compare the teleconsultation to the in‐person consultation: (i) only the length of time that patients spent with a clinician in an in‐person consultation was accounted; and (ii) in addition to the medical consultation, it was accounted the nursing screening.Mean labor costs per medical and nursing teleconsultations are Int$ 24 and Int$ 10, based on data analyses from 25,258 patients. Telemonitoring a patient with a daily call for seven days costs, on average, Int$ 14. COVID‐19 teleconsultation service represents, on average, an incremental access to medical consultation rate of 35% to 52% for the scenarios (i) and (ii), respectively.A COVID‐19 telehealth service contributes to increasing access to the healthcare service and can be included in the bundle of strategies offered in a public system that looks for more sustainable strategies to provide care.Classification of Research: Cost AnalysesMethod: Cost AnalysesResults: Throughout the study, 25,258 patients were accessed and 35,475 nursing teleconsultations, 20,876 medical teleconsultations and 100,890 telemonitoring calls performed by undergraduate students were carried out. Mean labor costs per medical and nursing teleconsultations were Int$ 24 and Int$ 10, respectively . Telemonitoring a patient with a daily call for seven days costed, on average, Int$ 14. The mean monthly cost for the medical teleconsultation service was Int$ 38,115, that represents, on average, an incremental access to medical consultation rate of 35% to 52% for the scenarios (i) and (ii), respectively, and considering the current consumed budget for this service.Conclusions: COVID‐19 telehealth service can increase access to the healthcare system and is a cost‐saving strategy. This information is valuable for managers, to better allocate and plan public funding for healthcare services to the population. In the context of scarce resources to deliver care with quality and safety to the population, the study was also a pioneer in estimating how a telehealth service contributes to increasing access to the healthcare system to the population.O‐8. EARLY EXPERIENCE WITH AN ASYNCHRONOUS TELEHEALTH COVID‐19 ANTIVIRAL TREATMENT PROTOCOLAnders Carlson, MD, Kristine Robb, Spat Shakya, Lisa Ide, MDZipnosis by DocSquadDescription: The antiviral combination medication nirmatrelvir/ritonavir has been FDA authorized for emergency use during the COVID‐19 public health emergency. When used in appropriate patients, treatment can significantly reduce COVID‐19 related hospitalization and death. We present the findings of an asynchronous telehealth solution for prescribing nirmatrelvir/ritonavir to appropriate candidates for therapy.Abstract: The antiviral combination medication nirmatrelvir/ritonavir (Paxlovid, Pfizer, New York, NY) has been authorized for use in COVID‐19 positive patients over age 12 and weighing more than 88 pounds who are at high risk for disease related to the virus. It has been shown to greatly reduce hospitalization and death from COVID‐19. Primary care and urgent care clinics needed to quickly adapt to the high demand and uncertain availability of this medication shortly after it was authorized. To aid in this workflow, we created an asynchronous telehealth protocol for symptomatic adult patients who have tested positive for COVID‐19 and have 5 days or less of mild to moderate symptoms. The protocol asks detailed questions about symptoms and medical history, and also asks patients about their kidney and liver health. If known, patients can enter their most recent estimated glomerular filtration rate (eGFR). Patients are also asked to upload a photo of their positive COVID‐19 test, if accessible. Based on the response to the adaptive interview questions, a clinician then reviews the patient responses and, if appropriate, sends an electronic prescription to the patient's preferred pharmacy through the telehealth platform.Classification of Research: Access to CareMethod: ObservationalResults: From June 8 to August 26, 2022, 659 visits were started for nirmatrelvir/ritonavir (81.8% of visits were completed), of which 416 visits (77%) resulted in a nirmatrelvir/ritonavir prescription. 123 visits (23%) did not have a prescription for nirmatrelvir/ritonavir (most of which (80%) clinicians diagnosed “COVID‐19 Infection: Paxlovid not recommended”). Patients were majority age 30‐49, and mostly female. Average clinician response time was 5: 44 min (time from patient completion to clinician finalizing the diagnosis/treatment plan), with average diagnosis time of 50 seconds (time from clinician opening visit to rendering diagnosis/assessment). Support calls were mostly related to pharmacy questions regarding kidney function.Conclusions: An asynchronous protocol to prescribe nirmatrelvir/ritonavir to appropriate symptomatic adult patients is an efficient alternative to conventional methods, with a high number of patients completing the protocol questions receiving a prescription for nirmatrelvir/ritonavir. Considering the time and resource burden to primary/urgent care clinicians and their staff, a telemedicine protocol assessing COVID‐19 positive patients for the appropriate use of antiviral therapy could be a time‐saving approach and keep symptomatic patients out of the physical clinic space. Support calls regarding kidney function remain an issue. Additional research into clinical outcomes and cost savings will be performed as more visits are completed.O‐9. EMERGENCY DEPARTMENT VIRTUAL ROUNDING – A STRATEGY FOR A PANDEMIC AND BEYONDJoshua BriscoeEmergency Physicians Central Florida, LLCDescription: Background: COVID‐19 surges led to excessive crowding in the ED and increases in patients leaving without being seen.Objective: Evaluate virtual telehealth rounding (VTR) in the ED on the prevalence of left without being seen (LWBS) dispositions during the pandemic and its effect on mortality and patient safety.Abstract: The trial of VTR took place for 107 days in December 2021‐April 2022 and ran for 65 days (8‐hours a day). The remaining 42 days served as a comparison group. During VTR, patients were triaged per usual upon arrival. Those patients with triage acuity categories II to V who were triaged to the waiting room were then evaluated virtually by a remote clinician after their initial screening examination using a secure virtual health platform. Patients were then reevaluated at 1‐2 hour intervals if necessary. They expedited care by ordering diagnostics, changing the patient's triage category, and determining early disposition according to usual clinical practice. Patients were then either left in the waiting room, taken for radiography and/or blood work, or taken back to a room in the ED where they were seen by an onsite ED physician. ED paramedics were available onsite to take vital signs, transport patients, and communicate directly with the onsite nurses and physicians. The main outcome was the LWBS rate, including LWBS before and after triage, patients leaving against medical advice and elopements. Secondary patient outcomes included in‐hospital mortality and improved patient safety defined as care that was urgently/emergently escalated by VTR.Classification of Research: Clinical OutcomesMethod: We conducted a cross sectional study on patients presenting to a level 1 trauma and tertiary referral center who were triaged to the waiting room.Results: There were 19,958 patients included, 6,953 (35%) evaluated via VTR & 13,006 (65%) received standard of care. Acuity levels at triage were II 24%, III 54%, IV 22%, & V 1%. Mean triage levels were 2.95 (95%CI 2.94‐2.97) in the VTR group & standard at 3.07 (95%CI 3.06 – 3.09). The proportion of LWBS was 565 (8%) in VTR patients & 3,246 (25%) in the standard group (p < 0.001). Overall, 27 (0.1%) patients did not survive to discharge, 7 (0.1%) VTR patients & 20 (0.2%) in the standard group (p = 0.421). VTR clinicians documented “great saves” in 5% of encounters.Conclusions: This novel approach to triage in t