Study Finds ED Standard Care Quality Equal to Virtual Care

Researchers at Stanford Health Care have found evidence that indicates the quality of virtual care provided to low-acuity patients at Stanford Health Care’s emergency department is equal to that of standard care procedures. In order to resist the disruption to treatment provision caused by the COVID-19 pandemic, Stanford Health Care chose to expedite the implementation of its strategy to incorporate virtual visits into clinical care in December of 2020. 

The medical system changed its current ED Fast Track care unit to a Virtual Visit Track as part of the acceleration. According to data published in the NEJM Catalyst case study, low-acuity patients frequently have to wait a long time in an ED because higher-acuity patients are given priority. Stanford Health Care established the Fast Track unit, made up of doctors, nurses, and emergency department personnel, to address this issue. This unit’s goal was to treat low-acuity patients as rapidly as possible.

In response to an increase in COVID-19 cases, Stanford’s adult and pediatric EDs switched from the Fast Track to the Virtual Visit Track (VVT). In the VVT, a lone doctor in a satellite site uses telemedicine to assess low-acuity ED patients with the help of VVT-trained support staff. 2,232 patients received care through the VVT in the first year of its introduction. There has been a consistent patient volume of 12 patients seen during an eight-hour shift through the VVT since around seven months following the introduction. The median ED length of stay for VVT patients was 1.9 hours, compared to 4.2 hours for patients who got care via normal ED workflows, according to an analysis of the care given through the VVT. Additionally, 66 percent of VVT doctors evaluated their ability to provide treatment comparable to an in-person consultation as “very good,” while 34 percent ranked it as “excellent.” Furthermore, Patients with VVT also had a reduced median rate of follow-up visits. In comparison to patients receiving standard care procedures, the median rate of return after 72 hours of the initial ED visit was 6.7 percent for VVT patients as opposed to 7.2 percent. Similar to this, patients with VVT had a median return visit rate of 10.4 percent as opposed to 12.4 percent for patients with conventional care workflow, making them marginally less likely to attend the ED again within seven days. 

The case study’s data indicates that VVT visit quality is likely not inferior to conventional care processes for low-acuity patients, despite no significant statistical difference in rate. The researchers conclude that “a VVT program can be used in other situations in which options for in-person evaluation are limited.”