Study shows tele‑emergency care could ease strain on crowded EDs
As emergency departments across the country continue to face crowding and long wait times, tele-emergency care may help steer appropriate cases away from already strained ERs, according to a new national study led by the Department of Emergency Medicine's Dr. Kathy Li.
The study, supported by the Emergency Medicine Foundation’s Value of Emergency Medicine Grant and the VA Quality Enhancement Research Initiative, reviewed 2.5 million calls made to the Veterans Health Administration’s nurse advice line between 2018 and 2024.
Out of those calls, nearly 100,000 veterans were offered a virtual visit with an emergency clinician instead of being sent directly to an emergency department.
Those who used tele-emergency care were much less likely to end up in the ER within a week. Their emergency visits dropped from 45% to 28.5%, representing a 36.6% relative reduction, with the biggest impact among higher-acuity callers.
These findings build on Li’s earlier work evaluating a pilot site implementing tele-emergency care, which saw emergency visits cut nearly in half among those who used tele-emergency care. The pilot also showed that the service could handle a wide range of medical concerns, and the virtual approach saved the VA an estimated $248 per avoided ER visit, helping reduce both travel and time burdens for veterans.
The new national analysis also found that results were about the same whether the tele-emergency visit happened by phone or video and whether the clinician was a physician or an advanced practice clinician (nurse practitioner or physician assistant). These similarities suggest health systems have flexibility in how they build and staff tele-emergency programs without sacrificing quality or safety.
The study also showed that veterans who used tele-emergency care were slightly less likely to be hospitalized, and importantly, there was no increase in deaths within 30 days. This suggests that reducing emergency visits did not compromise safety.
While individuals who used tele-emergency care saw a 36.6% drop in ER visits, the overall impact at the facility level was smaller and mainly seen in higher-acuity cases, potentially because only 17 percent of eligible nurse triage calls actually led to a tele-emergency visit.
Li notes that a more consistent offering of virtual care during nurse triage could help facilities see larger systemwide gains. She also hopes that these findings will encourage broader adoption of tele-emergency care beyond the VA to increase access to emergency expertise and help patients navigating urgent health concerns connect with the right care at the right time.
