We don’t normally think of telemedicine within the context of the emergency department. After all, the ED is where you go in the midst of a medical emergency. And yet a new study out of the University of Wisconsin shows there is a place for telemedicine in the ED. If it catches on, it could open up new opportunities for emergency medicine clinicians.
The study took place over three years and measured the rates of ED visits among seniors with dementia. Patients were divided into two groups. The control group did not undergo any changes to their care; the test group was given access to telemedicine in addition to normal care procedures. When all was said and done, the study group had visited the ED less frequently.
How Patients Were Treated
A total of 731 patients with dementia were followed during the three-year study. Each of the patients was being cared for at a senior living facility. As for the two groups, 517 were in the control group while 214 were in the study group.
All of the patients in the study group began with an initial in-person visit with a trained clinician. Each patient’s medical history and current medications were recorded. A thorough physical was also performed. Data gleaned from these in-person visits was then uploaded to a medical record system.
Whenever a study group patient felt the need to see the doctor, telemedicine was employed first. An emergency call was placed to the ED and the patient was first interviewed by a physician or registered nurse. The patient was evaluated to determine whether or not a visit to the ED was warranted.
The program was designed to be a high-intensity acute telemedicine program capable of offering an extensive range of services. Telemedicine physicians were able to prescribe medications, give instructions to care providers, and even order lab tests.
Reducing ED Visits
Surprisingly enough, the study yielded incredibly positive results. According to the data, those patients in the study group made actual visits to the ED 23.7% less than baseline over three years. Those in the control group increased their ED visits by 4.5%.
Treat and release rates declined among both groups; 20% for the study group and 2.2% for the control group. Finally, admission rates among study group participants fell by 25% while increasing among control group participants by more than 11%.
It is clear from the data that the use of telemedicine to treat senior dementia patients cuts ED usage significantly. That means more beds for other patients and frees up emergency medicine clinicians to focus their attentions on more serious cases. Staying out of the ED is also helpful to patients as well.
Not a Good Environment
Researchers at the University of Wisconsin recognized in the early days of their study that the ED is not always a good environment for dementia patients. Such patients have trouble enough coping in a familiar environment in which everything is tightly controlled. Take them out of that environment and put them in a busy ED, and patients can quickly lose their equilibrium.
EDs are especially stressful for dementia patients just by their very nature. So allowing them to stay where they are and receive care via telemedicine eliminates most of that stress. If it turns out a patient does need to visit the ED, very little was lost by conducting a telemedicine interview first.
Telemedicine does work in the ED for certain kinds of cases. Now that we know it works for senior dementia patients, could it be put to use in other ways?
