In some regions Emergency Department visits have increased at twice the rate of population growth, extending already long wait-times and delays in accessing care. Emergency room visits are also costly, adding to the financial strain of health systems whose resources are stretched to capacity. This is why so many health systems are evaluating virtual ED solutions as a way to divert non-acute patients away from physical emergency department visits and into other care pathways.
Diversion is held out as a solution to the persistent problem of ED overcrowding and long wait-times. But too often diversion is thought of as moving simple, non-complex care out of ED into other settings so that scarce resources (hospital beds, EM physicians) can be focused on those who need them most. In reality, it’s not the treatment of low- acuity patients that causes the chronic overcrowding and “hallway healthcare” that plagues EDs, as low acuity patients are already streamed to less intensive areas and aren’t typically overly expensive or time consuming to treat.
And the pandemic has identified another group of patients contributing to the problem, those who are now avoiding care until a crisis becomes unavoidable.
Clearly reducing Emergency Department visits and admissions is critical to improving the delivery of care, but are low acuity diversions themselves the right benchmark to focus on?
To answer this question, we need to first ask: “how many of these patients could have avoided what they perceived or experienced as ‘acute’ care circumstances requiring an emergency room visit, if we’d made it easier for the patient to access the right care, in the right setting, at the right time in their care journey?”
In short, should we be focusing on making health care services accessible earlier in the care pathway for patients with complex needs, before the patient experiences what they perceive as a health crisis, rather than diverting patients with low acuity issues. This approach would also potentially reduce Hospital admissions for patients that are not acute, but cannot safely be routed to low acuity care pathways and avoid the admission burdens ranging from hospital acquired infections, falls, delirium and deconditioning.
Put another way, the ED challenges don’t simply walk through the Emergency department doors get treated and go home; they linger because their complex care needs don’t require them be hospitalized, but they remain there nevertheless, because they can’t safely be discharged home. These patients may well have been ‘diverted’ from ever arriving in emergency, if they could have just accessed care earlier in their care journey.
Four fundamental problems Virtual ED solves by making healthcare services more easily accessible
1) Early Access to Appropriate Treatment
Patients with chronic conditions are often reluctant (either due to COVID or a dislike of long wait times) to visit an emergency department until they are in crisis. Virtual ED enables the delivery of care without the need for in-hospital treatment, which increases the likelihood of patients reaching out for help before a health crisis occurs.
2) …at the Right Time, in the Optimal Setting
Virtual ED does not have to resolve the patient’s issues in real-time; it can be used in conjunction with home care services (starting an IV, portable EKG) to provide optimal care without hospitalization and its attendant costs and potential complications. Many issues don’t require same-day intervention or investigation but rather can be connected to clinical and diagnostic services and care providers over several days.
3) Enable Coordinated Care
Doctors can have the confidence that their home care orders are being delivered properly and improve their trust in the system and the process, without worrying about care delivery disconnects or failures of care transitions.
4) Establish a Channel of Contact & Communication
Many patients visit physical emergency departments simply because they don’t know where to go and can’t reach their primary care physician. What they’ve really lost is contact and communication. Virtual ED provides that channel of communication and self- care guidance.
Reducing Emergency Department visits and admissions is clearly a valid goal, but enabling patients to connect and communicate with physicians earlier in their care pathway, with less anxiety and logistical challenges is a far better way of reducing Emergency Department visits and admissions than diverting patients once they’re in crisis.