Tele-emergency medicine connects providers at a central hub emergency department to providers and patients at spoke (often small, remote, or rural) hospitals through video or similar telehealth technology.
Tele-emergency typically involves a provider at a spoke hospital connecting with a provider at a hub hospital. The spoke provider interacts with patients, manages the video technology, shares vitals, and executes hands-on procedures. The hub provider may consult on a diagnosis, provide a second opinion, or guide the spoke provider through a complicated procedure.
Benefits of tele-emergency services:
- Provide expert care for patients.
- Build confidence by ensuring patients get the best care.
- Patients receive care closer to home.
- Expand capabilities of the spoke hospital to have more access to providers who have experience with a wide range of conditions.
- Initiate care faster by not having to wait for specialists to arrive or patients to be transferred.
- Keep small hospitals in business.
Tele-emergency is especially important during COVID-19 to help:
- Decrease the number of patients transferred to larger hospitals that may already be at or above maximum capacity.
A challenge with tele-emergency care is the distance between the hub provider and patient. To help bridge this gap, it’s important to invest in open communication and collaboration between the hub and spoke providers. In addition to the items on the getting started page, consider:
- What software you will use — if you need new technology, if your existing telehealth platform is sufficient, or if new integrations are available for your current platform
- What hardware you will use — if you will equip each patient’s room with a device or have a mobile station you move from room to room
Tip: For technology-related help, visit the National Telehealth Technology Assessment Resource Center .
Staffing and training
- How to best staff your providers at the spoke locations — what skills are most needed
- How you will train your spoke providers to manage the technology and common procedures
- Will you have hub providers dedicated entirely to telehealth or mix it along-side in-person visits
Communication and collaboration
- How you will establish clear and open communication with on-site providers to build trust and a collaborative relationship
- How you will share expectations of the providers at the hub and spoke sites
- Who at your spoke site will be your telehealth champion to help get staff buy-in
- What kinds of cases warrant initiating a tele-emergency call — consider tiers for required, recommended, or optional
- What charges are billed per call, and which are covered by a flat fee
- What the hub providers and spoke providers will each be responsible for
- How patient records will be shared — it can be especially challenging if participating hospitals don’t use the same electronic health record platform
- How will you balance workload, especially if the hub provider is also managing in-person patients
- How and who will manage documentation
- What protocols you will use for sanitizing equipment after use
- How you will handle informed consent
Your workflow will vary depending on your particular set up but will likely have these basic elements.
- The spoke team initiates a call to the hub while they provide immediate care.
- The hub team answers the call, and they discuss the patient’s details and level of support needed.
- The hub team connects via video platform to interact directly with the patient and spoke team.
- The spoke team relays information to the hub team and performs procedures.
- Both teams discuss further treatment, if transfer or transport is needed, and finalize documentation.
More information about tele-emergency:
- Insider tips from a telehospitalist (video) — from the Heartland Telehealth Resource Center
- Emergency telemedicine consult and intake form templates — from the Northwest Regional Telehealth Resource Center
- How a Critical Access Hospital Can Become a Center — from the Northwest Regional Telehealth Resource Center
SpotlightsUniversity of Mississippi Medical Center
The University of Mississippi Medical Center (UMMC) tele-emergency program partners with over 20 hospital emergency departments across Mississippi. The over 60 advance practice providers at the partner “spoke” locations can connect to an emergency specialist who can assist with everything from diagnosing rare conditions to delivering babies. Read more about the UMMC emergency telemedicine program which, as of November 2020, has served over 300,000 patients.
Avera eCare Emergency partners with over 180 sites across the United States to alleviate pressure on rural ERs by promoting quality care and connection to their experienced clinical teams. Avera eCare uses robust data collection and reporting to help measure and ensure quality performance. Read more about Avera eCARE Emergency .