‘Virtual ED’ Helps One Health System Avoid Unnecessary Emergency Department Visits

WASHINGTON — Use of a “virtual” emergency department (ED) has saved several patients from unnecessary ED trips in its first few weeks of operation, Sidney “Beau” Raymond, MD, said here Thursday at the fall conference of the National Association of ACOs (NAACOS).

“When you talk about impact on people who are going to emergency departments, we know that about 50% of people that are going there are preventable or unnecessary [visits],” said Raymond, who is chief medical officer of Ochsner Health Network in New Orleans. “So with that, we have been looking at opportunities” to improve.

Ochsner has had a 24/7 nurse triage line for a long time, “and with that triage protocol, patients are identified that need to be seen in a very short time frame [either] by a primary care doctor or by urgent care, or someone else,” he added.

The triage nurse “normally would tell that patient to go to the emergency department because they wouldn’t be able to be seen in a timely fashion by their doctor,” he continued. But with the virtual ED, “that patient would be referred to an emergency doctor who’s in a bunker” and has access to the patient’s chart. The interaction “may just be a phone call, or they may do a virtual visit, but they’re giving guidance and care to those patients. The nurse on the triage line can only go as far as their license can go, but the ED docs are able to do a little bit more.”

Of the 300 patients referred to the virtual ED in the program’s first 2 weeks, “half the people were able to be redirected to either get taken care of at home, or they got into a primary care office or to urgent care, and did not go to the ED,” Raymond said. “So there was a significant impact.” The moral of the story? “Just think about things that are going on, use your data, find out where your opportunities are, and create something new.”

Raymond also discussed Ochsner’s Connected Care program to improve metabolic factors for patients with diabetes or hypertension. Under the program, “a patient has a device, a glucometer or a blood pressure cuff that [is connected via] Bluetooth to their phone, and their phone then sends tons of readings to us on a regular basis,” he explained. The data come into the health system and get fed into the patient’s medical record, “and from there, we have algorithms that highlight where opportunities are for those patients … We have health coaches who will reach out to them and say, ‘Hey, you haven’t taken your reading in a while. Why don’t you go ahead and do that?’ They’ll also interact with you about a diet or exercise plan. So it’s more than just getting readings — it’s way more than that.”

The health system’s pharmacists also get involved by monitoring how the patients are responding to their medications and then intervening as necessary, Raymond said. “They interact with those patients, and they look and see how they respond to the medications, and bump them up as they go. And then there’s lots of tech support and other things too.”

When the program started, primary care physicians were concerned that it was “taking away the easy stuff … hypertension, diabetes, routine care that they’re all used to — it was like, ‘Well, I’m not going to have those visits anymore,'” he added. “Well, amazingly, people are now engaged in their care, and they actually came in just a little bit more than they used to, so they didn’t lose any visits to this whatsoever. And a lot of the doctors actually focus on bigger events.”

The program, which now has about 40,000 participants, is geared not to the super “low-touch” patients or those who are very high maintenance, but to those in the middle — “those people who have chronic conditions and we’re trying to get them under control,” said Raymond. On the patient side, “they’re getting information regularly reported back down through the app, so they’re able to see how they’re doing. They know where they stand. And there are also educational materials that go out to them as well [to show them] where they are and what they need to be doing differently.”

The program has resulted in decreased ED visits and inpatient admissions, which in turn is a financial benefit for Ochsner, he said. “It’s a three-to-one return on investment … We continue to use it and to try to think of new ways to do this.”