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Best practice guide

Telehealth for emergency departments
For providers Best practice guides Telehealth for emergency departments

Tele-emergency care

Tele-emergency medicine connects providers and patients at spoke hospitals (often small, remote, or rural) with providers at a central hub emergency department through video or similar telehealth technology.

About

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

Benefits of tele-emergency services:

  • Provide expert care for patients.
  • Build confidence by ensuring patients get the best care.
  • Deliver care closer to patients’ homes.
  • Expand capabilities of the spoke hospital through access to providers with a wider range of experience.
  • 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.

Getting started

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:

Technology

  • 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 exit disclaimer icon .

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
  • If hub providers will be dedicated entirely to telehealth or also managing 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

Logistics

  • What kinds of cases warrant initiating a tele-emergency call — consider tiers for required, recommended, or optional
  • Which 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

Example workflow

Your workflow will vary depending on your particular set up but will likely have these basic elements.

  1. The spoke team initiates a call to the hub while they provide immediate care.
  2. The hub team answers the call, and they discuss the patient’s details and level of support needed.
  3. The hub team connects via video platform to interact directly with the patient and spoke team.
  4. The spoke team relays information to the hub team and performs procedures.
  5. Both teams discuss further treatment, if transfer or transport is needed, and finalize documentation.

More information about tele-emergency:

Spotlights

University 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 exit disclaimer icon  which, as of November 2020, has served over 300,000 patients.


Avera eCare

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 exit disclaimer icon .


Last updated: February 9, 2021