The Evolving Role of Telemedicine within the Emergency Department
Telemedicine in Emergency Department
DOI:
https://doi.org/10.30953/thmt.v10.591Keywords:
Emergency Department, patient care, healthcare systems, telemedicineAbstract
The emergency department (ED) is a critical area not only for patient care, but it’s impact on overall hospital operations as well. Performance metrics within the ED are not only important for the ED but for the hospital as well. However, the global burden on EDs continues to rise, with overcrowding and prolonged boarding driving excessive waiting times, delayed treatments and poorer outcomes. The 3 main and interdependent components of ED patient flow consists of input, throughput and output. Incorporation of telemedicine solutions into the assessment, analysis and treatment of ED patients can aid in relieving this burden. However, only sporadic uses of ED telemedicine projects have been published. Health systems should consider a comprehensive telehealth strategy for the entire patient journey and ED operation.
Downloads
References
Hassan E. Tele-Critical Care at 25 years old. Telehealth and Medicine Today 2024.9.490; https://doi.org/10.30953/thmt.v9.490.
National Center for Health Statistics. Emergency Department Visits in the United States, 2016-2022. Generated interactively: April 2, 2025 from https://www.cdc.gov/nchs/dhcs/ed-visits/index.htm
Emergency Medicine Practice Committee, ACEP. Emergency Department Overcrowding: High Impact Solutions; ACEP: Irving, TX, USA, 2016.
Savioli G, Ceresa IF, Gri N, Piccini GB, Longhitano Y, Zanza C, Piccioni A, Esposito C, Ricevuti G, Bressan MA. Emergency department overcrowding: Understanding the factors to find corresponding solutions. Journal of Personalized Medicine 2022;12:279. https://doi.org/10.3390/jpm12020279.
Cairns C, Kang K. National Hospital Ambulatory Medical Care Survey: 2021 emergency department summary tables. Available from: https://ftp.cdc.gov/pub/Health_Statistics/NCHS/ Dataset_Documentation/NHAMCS/doc21-ed-508.pdf.
Uscher-Pines L, Pines J, Kellerman A, Gillen E, Mehrotra A. Emergency department visits for nonurgent conditions: systematic literature review. Am J Manag Care 2013:19(1):47-59. PMID: 23379744.
Laam LA, Wary AA, Strony RS, Fitzpatrick MH, Kraus CK. Quantifying the impact of patient boarding on emergency department length of stay: All admitted patients are negatively affected by boarding. JACEP Open 2021;2:e12401 doi: 10.1002/emp2.12401
Mohr NM, Wessman BT, Bassin B, Elie-Turenne MC, Ellender T, Emlet LL, Ginsberg Z, Gunnerson K, Jones KM, Kram B, Marcolini E, Rudy S. Boarding of critically ill patients in the emergency department. Crit Care Med 2020;48(8):1180-1187. doi: 10.1097/CCM.0000000000004385.
Richardson DB. Increase in patient mortality at 10 days associated with emergency department overcrowding. M J of Australia 2006. https://doi.org/10.5694/j.1326-5377.2006.tb00204.x
Guttmann A, Schull MJ, Vermeulen MJ, Stukel TA. Association between waiting times and short term mortality and hospital admission after departure from emergency department: Population based cohort study from Ontario Canada. BMJ 2011. 10.1136/bmj.d2983. doi: 10.1136/bmj.d2983.
Cha WC, Shin SD, Cho JS, Song KJ, Singer AJ, Kwak YH. The association between crowding and mortality in admitted pediatric patients from mixed adult-pediatric emergency departments in Korea. Pediatric Emergency Care 2011;27(12):1136-1141. doi: 10.1097/PEC.0b013e31823ab90b.
Chalfin DB, Trzeciak S, Likourezos A, Baumann BM, Dellinger RP, DELAY-ED study group. Impact of delayed transfer of critically ill patients from the emergency department to the intensive care unit. Crit Care Med 2007; 35:1477–1483. doi: 10.1097/01.CCM.0000266585.74905.5A
Agustin M, Price LL, Andoh-Duku A, LaCamera P. Impact of delayed admission to the intensive care unit from the emergency department upon sepsis outcomes and sepsis protocol compliance. Crit Care Research and Practice 2017; http://dx.doi.org/10.1155/2017/9616545.
Singer AJ, Thode HC Jr, Viccellio P, Pines JM. The association between length of emergency department boarding and mortality. Acad Emerg Med 2011; 18:1324–1329. doi: 10.1111/j.1553-2712.2011.01236.x.
Cardoso LTQ, Grion CMC, Matuso T, Anami HT, Kauss IAM, Seko L, Bonametti AM. Impact of delayed admission to intensive care units on mortality of critically ill patients: A cohort study. Critical Care 2011;15:R28. http://ccforum.com/content/15/1/R28. doi: 10.1186/cc9975. Epub 2011 Jan 18.
Hollander JE, Sharma R. The availabilists: Emergency care without the emergency department. NEJM Catalyst December 21, 2021. https://catalyst.nejm.org/doi/full/10.1056/CAT.21.0310
Langabeer JR, Gonzalez M, Alqusairi D, Champagne-Langabeer T, Jackson A, Mikhail J, Persse D. Telehealth-enabled emergency medical services program reduces ambulance transport to urban emergency departments. Western J of Emergency Medicine 2016;17:713-720. doi: 10.5811/westjem.2016.8.30660. Epub 2016 Sep 6.
Schaefer RA, Rea T, Plorde M, Peiguss K, Goldberg P, Muarry JA. An emergency medical services program of alternate destination of patient care. Prehosp Emerg Care. 2002;6(3):309-14. doi: 10.1080/10903120290938355.
Snooks H, Dale J, Hartley-Sharpe C, Halter M. On-scene alternatives for emergency ambulance crews attending patients who do not need to travel to the accident and emergency department: a review of the literature. Emerg Med J. 2004;21(2):212-5. doi: 10.1136/emj.2003.005199
Potter J, Gans DW, Gardner A, O’Neill J, Watkins C, Husain I. Using virtual emergency medicine clinicians as a health system entry point (virtual first): Cross-sectional survey study. J Med Internet Res 2023;25:e42840 doi: 10.2196/42840.
Kowark, A., Felzen, M., Ziemann, S. Wied S, Czaplik M, Beckers SK, Brokmann JC, Hilgers RD, Rossaint R, TEMS-study group. Telemedical support for prehospital emergency medical service in severe emergencies: an open-label randomised non-inferiority clinical trial. Crit Care 27, 256 (2023). https://doi.org/10.1186/s13054-023-04545-z.
Boonstra A, Laven M, Influence of artificial intelligence on the work design of emergency department clinicians a systematic literature review. BMC Health Services Research 2022;22:669. https://doi.org/10.1186/s12913-022-08070-7.
Greenbaum NR, Jernite Y, Halpern Y, Calder S, Nathanson LA, Sontag DA, Horng S. Improving documentation of presenting problems in the emergency department using a domain-specific ontology and machine-learning-driven user interface. Int J Med Inform 209:132:103981. doi: 10.1016/j.ijmedinf.2019.103981.
Shin HA, Kang H, Choi M. Triage data-driven prediction models for hospital admission of emergency department patients: A systematic review. Health Inform Res 2025;31(1):23-36. https://doi.org/10.4258/hir.2025.31.1.23.
Brossard C, Goetz C, Catoire P, Cipolat L, Guyeux C, Jardine CG, Akplogan M, Vuillaume LA. Predicting emergency department admissions using a machine learning algorithm: a proof of concept with retrospective study. BMC Emergency Medicine 2025;25:3 https://doi.org/10.1186/s12873-024-01141-4.
Cameron A, Rodgers K, Ireland A, Jamdar R, McKay GA. A simple tool to predict admission at the time of triage. Emerg Med J 2015;32: 174–179. doi: 10.1136/emermed-2013-203200. Epub 2014 Jan 13.
Levin S, Toerper M, Hamrock E, Hinson JS, Barnes S, Gardner H, Dugas A, Linton B, Kirsch T, Kelen G. Machine-learning-based electronic triage more accurately differentiates patients with respect to clinical outcomes compared with emergency severity index. Ann Emerg Med 2018;71(5):565-574. doi: 10.1016/j.annemergmed.2017.08.005. Epub 2017 Sep 6.
Hong WS, Haimovich AD, Taylor RA. Predicting hospital admission at emergency department triage using machine learning. PLoS ONE 13(7): e0201016. https://doi.org/10.1371/ journal.pone.0201016.
Cusido J, Comalrena J, Alavi H, Llunas L. Predicting hospital admissions to reduce crowding in the Emergency departments. Appl. Sci. 2022, 12, 10764. https://doi.org/10.3390/ app122110764.
Akhlaghi H, Freeman S, Vari C, McKenna B, Braitberg G, Karro J, Tahayori B. Machine learning in clinical practice: Evaluation of an artificial intelligence tool after implementation. Emergency Medicine Australasia 2024;36:118-124. doi: 10.1111/1742-6723.14325. Epub 2023 Sep 28.
Gomez, J, Cochran, A, Patterson, B Zayas-Caban, G. Evaluation of a Split Flow Model for the Emergency Department. 2022. doi:10.48550/arXiv.2202.00736.
Joseph A, Patel A, Robinson RD, Andersen CA, Zenarosa NR, DeMoor C, Wang H. The role of split-flow model in the improvement of emergency department efficiency with respect to patients presenting with different acuity levels. Annals of Emergency Medicine 2013;62(4), Suppl:S1-S2. doi: 10.1016/j.annemergmed.2013.07.289
Batt RJ, Terwiesch C. Early task initiation and other load-adaptive mechanisms in the emergency department. Management Science 2017;63(11):3531-3551. https://doi.org/10.1287/mnsc.2016.2516
Burstrum L, Nordberg G, Ormung M, Castren M, Wiklund T, Engstrom ML, Enlund M. Physician-led team triage based on lean principles may be superior for efficiency and quality? A comparison of three emergency departments with different triage models. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2012;20(1):1-10. doi: 10.1186/1757-7241-20-57.
Russ S, Jones I, Aronsky D, Dittus RS, Slovis CM. Placing physician orders at triage, the effect on length of stay. Annals of Emergency Medicine 2010;56(1):27-33. doi:10.1016/j.annemergmed.2010.02.006. Epub 2010 Mar 16
Traub SJ, Stewart CF, Didehban, R, Bartley AC, Saghafian S, Smith VD, Silvers SM, LeCheminant R, Lipinski CA. Emergency department rotational patient assignment. Ann Emerg Med 2016; Feb; 67(2):206-215. doi: 10.1016/j.annemergmed.2015.07.008. Epub 2015 Oct 6.
Whitt W, Zhang X. Forecasting arrivals and occupancy levels in an emergency department. Oper Res Health Care 2019;21(1):1-18. https://doi.org/10.1016/j.orhc.2019.01.002Get rights and content
Cheng Q, Argon NT, Evans CS, Liu Y, Platts-Mills TF, Ziya S. Forecasting emergency department hourly occupancy using time series analysis. Am J Emerg Med.2021;48:177-182. doi: 10.1016/j.ajem.2021.04.075. Epub 2021 Apr 29.
Harrow F, Dairi A, Kadri F, Sun Y. Forecasting emergency department overcrowding: a deep learning framework. Chaos Solitons Fractals. 2020;139:110247. doi: 10.1016/j.chaos.2020.110247. Epub 2020 Sep 21
Akbasli IT, Birbilen AZ, Teksam O. Artificial intelligence-driven forecasting and shift optimization for pediatric emergency department crowding. JAMIA Open 2025;8(2):ooae138. https://doi.org/10.1093/jamiaopen/ooae138.
Soster CB, Anschau F, Rodrigues NH, Gabriela L, da Silva A, Klafke A. Advanced triage protocols in the emergency department: A systematic review and meta-analysis. Rev. Latino-Am. Enfermagem 2022;30:e3511 doi: 10.1590/1518-8345.5479.3511.
Franklin BJ, Li KY, Somand DM, Kocher KE, Kronick SL, Parekh VI, Goralnick E, Nix AT, Haas NL. Emergency department provider in triage: Assessing site-specific rationale, operational feasibility, and financial impact. JACEP Open 2021;2:e12450 https://doi.org/10.1002/emp2.12450.
Rowe BH, Villa-Roel C, Guo X, Bullard MJ, Ospina M, Vandermeer B, Innes G, Schull M, Holroyd BR. The role of triage nurse ordering on mitigating overcrowding in emergency departments: A systematic review. Academic Emergency Medicine 2011; 18:1349–1357. doi: 10.1111/j.1553-2712.2011.01081.x. Epub 2011 Jun 21
Joshi AU, Randolph FT, Chang AM, Slovis BH, Rising KL, Sabonjian M, Sites FD, Hollander JE. Impact of emergency department tele-intake of left without being seen and throughput metrics. Academic Emergency Medicine 2020;27(2):139-147. doi: 10.1111/acem.13890. Epub 2019 Dec 26
Kadar RB, Amici DR, Hesse K, Bonder A, Ries M. Impact of telemonitoring of critically ill emergency department patients awaiting ICU transfer. Crit Care Med 2019;47(9):1201-1207. doi: 10.1097/CCM.0000000000003847.
Gunnerson KJ, Bassin NS, Harvey RA, Haas NL, Sozener CB, Medin RP, Gegenheimer-Holmes JA, Laurinec SL, Boyd C, Cranford JA, Whitmore SP, Hsu CH, Khan R, Vazirani NN, Maxwell SG, Neumar RW. Association of an emergency department-based intensive care unit with survival and inpatient intensive care unit admissions. JAMA Network Open. 2019;2(7):e197584. doi:10.1001/jamanetworkopen.2019.7584.
Abraham J, Kandasamy M, Fritz B, Konzen L, White J, Drewry A, Palmer C. Expanding critical care delivery beyond the intensive care unit: Determining the design and implementation needs for a tele-critical care consultation service. Appl Clin Inform 2024;15:178–191. doi:10.1055/s-0044-1780508
Howell E, Bessman E, Marshall R, Wright S. Hospitalist bed management effecting throughput from the emergency department to the intensive care unit. J Crit Care 2010;25(2):184-189. doi: 10.1016/j.jcrc.2009.08.004. Epub 2009 Oct 13
Lilly C, Motzkus C, Rincon T, Cody SE, Landry K. ICU telemedicine program financial outcomes. Chest 2017;151(2):286-297. doi: 10.1016/j.chest.11.029
Pollaris G, Sabbe M. Reverse triage: More than just another method. European Journal of Emergency Medicine 2016;23(4):240-247. doi: 10.1097/MEJ.0000000000000339
Kelen GD, McCarthy M, Kraus CK, Ding R, Hsu EB, Li G, Shahan JB, Scheulen JJ, Green GB. Creation of surge capacity by early discharge of hospitalized patients at low risk for untoward events. Disaster Med Pub Health Pop 2009; Jun; 3(2 suppl):s10-6. doi: 10.1097/DMP.0b013e3181a5e7cd.
Sartini M, Carbone A, Demartini A, Giribone L, Olivia M, Spagnolo AM, Cremonesi P, Canale F, Cristina ML. Overcrowding in the emergency department: Causes, consequences, and solutions – A narrative review. Healthcare 2022, 10, 1625. doi: 10.3390/healthcare10091625.
Boyle J, Jessup M, Crilly J, Green D, Lind J, Wallis M, Miller P, Fitzgerald G. Predicting emergency department admissions. Emerg Med J 2012 May;29(5):358-65. doi: 10.1136/emj.2010.103531. Epub 2011 Jun 24.
Weinick RM, Bruna S, Boicourt RM, Michael SS, Sessums LL. AHRQ Summit to address emergency department boarding. Technical Report. January 2025. www.ahrq.gov/sites/default/files/wysiwyg/topics/ed-boarding-summit-report.pdf.
Powell ES, Khare RK, Venkatesh AK, Van Roo BD, Adams JG, Reinhardt G. The relationship between inpatient discharge timing and emergency department boarding. J Emerg Med. 2012 Feb;42(2):186-96. doi: 10.1016/j.jemermed.2010.06.028. Epub 2010 Oct 2.
Bailey R, Segon A, Garcia S, Kottewar S, Lu T, Tiazon N, Sanchez L, Gelfond JA, Bowling G. Increasing and sustaining discharges by noon – a multi-year process improvement project. BMC Health Services Research 2024;24:478. https://doi.org/10.1186/s12913-024-10960-x.
Franklin BJ, Vokill S, Huckman RS, Hosein S, Falk N, Cheng K, Murray M, Harris S, Morris CA, Goralnick E. The inpatient discharge lounge as a potential mechanism to mitigate emergency department boarding and crowding. Annals of Emergency Medicine 2020;75(6);704-714. doi: 10.1016/j.annemergmed.2019.12.002. Epub 2020 Jan 23.
Hernandez N, John D, Mitchell J. A reimagined discharge lounge as a way to an efficient discharge process: BMJ Quality Improvement Reports 2014;3:u204930.w2080. doi: 10.1136/bmjquality.u204930.w2080. eCollection 2014.
Yun CC, Huang SJ, Kuo T, Li YC, Juang WC. Impact of new bed assignment information system on emergency department length of stay: An effect evaluation for lean intervention by using interrupted time series and propensity score matching analysis. International Journal of Environmental Research and Public Health 2022, 19, 5364. https://doi.org/10.3390/ ijerph19095364.
Barrett L, Ford Z, Ward-Smith P. A bed management strategy for overcrowding in the emergency department. Nurs Econ 2012 Mar-Apr;30(2):82-85. PMID: 22558725
Marsilio M, Roldan ET, Salmasi L, Villa S. Operations management solutions to improve ED patient flows: Evidence from the Italian NHS. BMC Health Services Research (2022) 22:974 https://doi.org/10.1186/s12913-022-08339-x.
Lee YC, Ng CJ, Hsu CC, Cheng CW, Chen SY. Machine learning models for predicting unscheduled return visits to an emergency department: A scoping review. BMC Emergency Medicine (2024) 24:20 https://doi.org/10.1186/s12873-024-00939-6.
Sung CW, Ho J, Fan CY, Chen CY, Chen CH, Lin SY, Chang JH, Chen JW, Huang EPC. Prediction of high-risk emergency department revisits from a machine-learning algorithm: A proof of concept study. BMJ Health Care Inform 2024;31:e100859. doi:10.1136/ bmjhci-2023-100859.
Kijpaisalratana N, El Ariss AB, Balk A, Mitragotri S, Samadian KD, Hahn BJ, Coleska A, Baugh JJ, Hassan A, Lee J, Raja AS, He S. Development and validation of the discharge severity index for post-emergency department hospital readmissions. American Journal of Emergency Medicine 2025;(94):125-132. doi: 10.1016/j.ajem.2025.04.045. Epub 2025 Apr 23.
Chavda E, Norberciak L, Moreau LG, Casalino E, Willatte L, Wiel E, Thellier N, Cordova E. Impact of a new post-emergency teleconsultation procedure on overcrowding. Digital Health 2024 doi: 10.1177/20552076241277173 journals.sagepub.com/home/dhj.
Inokuchi R, Sakamoto A, Sun Y, Iwagami M, Tamiya N. Combining conventional and telemedicine medical services to reduce the burden on emergency medical services in rural areas: A retrospective cohort study. Prehospital Emergency Care doi.org/10.1080/10903127.2025.2460205
Saffle J, Edelman L, Theurer L, Morris S, Cochran A. Telemedicine evaluation of acute burns is accurate and cost-effective. J Trauma 2009 Aug;67(2):358-365. doi: 10.1097/TA.0b013e3181ae9b02
Duchesne JC, Kyle A, Simmons J, Islam S, Schmieg RE, Olivier J, McSwain NE. Impact of telemedicine upon rural trauma care. J Trauma 2008 Jan;64(1):92-7; discussion 97. doi: 10.1097/TA.0b013e31815dd4c4
Mohr NM, Vakkalanka JP, Harland KK, Bell A, Skow B, Shane DM, Ward MM. Telemedicine use decreases rural emergency department length of stay for transferred North Dakota trauma patients. Telemed J E Health 2018 Mar;24(3):194-202. doi: 10.1089/tmj.2017.0083
Tsou C, Robinson S, Boyd J, Jamieson A, Blakeman R, Yeung J, McDonnell J, Waters S, Bosich K, Hendrie. Effectiveness of telehealth in rural and remote emergency departments: Systematic review J Med Internet Res 2021 | vol. 23 | iss. 11 | e30632. doi: 10.2196/30632
Westbrook JI, Coiera EW, Brear M, Stapleton S, Rob MI, Murphy M, Cregan P. Impact of an ultrabroadband emergency department telemedicine system on the care of acutely ill patients and clinicians' work. Med J Aust 2008 Jun 16;188(12):704-708. doi: 10.5694/j.1326-5377.2008.tb01850.x
Sterling SA, Seals SR, Jones AE, King MH, Galli RL, Isom KC, Summers RL, Henderson KA. The impact of the TelEmergency program on rural emergency care: an implementation study. J Telemed Telecare 2017 Jul;23(6):588-594. doi: 10.1177/1357633X16657499
Shalev L, Eitan R, Rose A. The use of telepsychiatry services in emergency settings: Scoping review. J Med Internet Res 2024 | vol. 26 | e51814. doi: 10.2196/51814.
Freeman RE, Zhong C, Bahar P, Boggs KM, Faridi MK, Sullivan AF, Zachrison KS, Camargo CA. U.S. emergency department telepsychiatry use in 2019. Telemedicine and e-health 2023;29(3): 366-375. doi: 10.1089/tmj.2022.0191
Farley HL, Troutman GA, Brown A, Enguidanos ER, Freess D, Killian M, Kirchhoff MA, Medford-Davis LN, Murphy CE, Nevel AE, Riviello R, Rosenberg MS, Russi CS, Turturro MA, Zun L. Practical solutions to boarding of psychiatric patients in the emergency department. American College of Emergency Physicians. ACEP Emergency Practice Committee White Paper October 2015.
Lee K, Jang K, Kim H, Bae G, Jang CS, Shin JH. Factors affecting the length of stay in the emergency department in psychiatric emergency patients in the COVID-19 pandemic context. Journal of Health Care Organization, Provision and Financing 2023;60:1-8. doi: 10.1177/00469580231167529. https://doi.org/10.1177/00469580231167529
Monahan Z, Mack A, Place A, Pierce A, Hartwell M. American emergency wait times for psychiatric conditions from 2019 to 2021. Emergency Care Journal 2024;20:12719. doi:10.4081/ecj.2024.12719
Saurman E, Kirby SE, Lyle D. No longer “flying blind”: how access has changed emergency mental health care in rural and remote emergency departments, a qualitative study. BMC Health Serv Res 15, 156 (2015). https://doi.org/10.1186/s12913-015-0839-7.
Fairchild RM, Ferng-Kuo SF, Laws S, Rahmouni H, Hardesty D. Telehealth decreases rural emergency department wait times for behavioral health patients in a group of critical access hospitals. Telemedicine and e-Health 2019:25(12):1154-1164 doi: 10.1089/tmj.2018.0227.
Patel SY, Huskamp HA, Barnett ML, Zubizarreta JR, Zachrison KS, Busch AB, Wilcock AD, Mehrotra A. Association between telepsychiatry capability and treatment of patients with mental illness in the emergency department. Psychiatric Services 2022; 73:403–410; doi: 10.1176/appi.ps.202100145.
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Erkan Hassan, PharmD
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors retain copyright of their work, with first publication rights granted to Telehealth and Medicine Today (THMT).
THMT is published under a Creative Commons Attribution-NonCommercial 4.0 International License.
