Telemedicine-Based Emergency Physician Assessment Prior to ED Entry: A Randomized Controlled Trial

Randomized Controlled Trial Comparing the Safety and Efficiency of a Virtual-Hybrid Emergency Department Model Versus Standard Emergency Department Management in Non-Urgent Patients

Background:

Emergency department (ED) overcrowding is a growing challenge worldwide and is associated with prolonged length of stay (LOS), reduced patient satisfaction, and increased burden on healthcare systems. New approaches are needed to improve how patients are evaluated and treated.

Telemedicine has been increasingly integrated into ED care and has shown feasibility and benefits in various settings. Existing models have demonstrated improvements in patient flow, reduced length of stay, and high patient satisfaction. However, despite the growing use of telemedicine in emergency medicine, there is a lack of randomized controlled trials evaluating its effectiveness and safety, particularly in models involving early remote physician assessment prior to ED evaluation.

Purpose:

This study aims to evaluate whether a video consultation with a senior emergency physician before entering the ED can improve the efficiency and quality of care. The study also examines whether physicians can accurately identify which patients need ED evaluation based on a remote assessment, while maintaining patient safety.

Methods:

A total of 200 adults who arrived at the ED were assigned to one of two groups. In the study group, participants had a video consultation with a physician before continuing with standard ED care.

In the control group, participants received standard ED care only.

During the video consultation, the physician performed an initial clinical assessment and could order tests or specialist consultations. The physician was also asked what their recommendation would have been if the participant had been assessed from home. Three possible decisions were recorded:

• Immediate ED presentation
• Scheduled ED presentation at a later time
• Continued care in the community without ED presentation

Outcomes:

The primary outcomes focus on the effectiveness of the intervention. These include:

• ED length of stay
• Patient satisfaction
• The ability of physicians to accurately identify participants who require ED evaluation The secondary outcome is safety, assessed by return visits to the ED within one week for the same complaint.

Inclusion Criteria:

• Adults aged 18 years and older
• Presentation to the emergency department during study recruitment hours
• Ability to provide written informed consent

Exclusion Criteria:

• Pregnancy
• Arrival by ambulance
• Severe pain, defined as a Visual Analogue Scale (VAS) score of 8 or higher
• Emergency Severity Index (ESI) level 1 or 2
• Language barriers or technological difficulties without an accompanying person able to assist
• Isolated orthopedic complaints with suspected fracture or dislocation
• Repeat emergency department visit for the same complaint within the previous 72 hours