Will new e-facility help fight ED overcrowding?
New site can positively effect LWBS, satisfaction
A newly opened telemedicine primary care facility in Peachtree City, GA, called Health-e-Station, will help curtail the severe overcrowding problems facing area EDs, according to its founder. What's more, he asserts, by keeping nonemergent patients out of EDs, it also will reduce the number of patients who leave without ever being seen and will significantly improve average wait times and patient satisfaction.
The first Health-e-Station in the nation (more are planned soon in Georgia), located in a shopping mall, is next to a 24-hour Kroger pharmacy. When the patient arrives, he or she is registered into the facility's computerized system by a medical assistant using a touch screen. "That information is immediately available to a physician who is in another location," explains Andy Agwunobi, MD, MBA, founder of Health-e-Station. Agwunobi also is a pediatrician, executive vice president and chief operating officer of St. Joseph Health System in Orange, CA, and immediate past president and CEO of Grady Health System in Atlanta.
"When the patient is taken into the examining room, the physician is already up on the plasma screen and welcomes and talks to the patient," he says.
Several Health-e-Station physicians are located in a separate facility from which they treat the current patients and will treat patients at future Health-e-Station locations.
The Health-e-Station equipment enables the physician to remotely examine the patient's ears, eyes, throat, and skin.
'Same truth to both sides'
While asserting this new concept will help ease ED overcrowding, Agwunobi, who himself has overseen EDs, acknowledges "there is some truth to both sides," noting a recent study from the American College of Emergency Medicine that asserts patients with minor ailments do not cause ED overcrowding. "Yes, there are certainly people in the EDs who are real emergencies, but if you look at the recent [Institutes of Medicine] report on emergency medicine, there is also agreement that some portion of those patients are nonemergent, and some studies have shown that up to 30% of visits to the ED are for nonemergent conditions."
Agwunobi goes on to say the actual percentage may be unknown and that the numbers will vary from facility to facility. "One thing we know for sure: When nonemergencies come in, they will wait longer — and rightly so. It is not unusual to wait all night and still not end up not being seen."
Accordingly, he says, facilities like his will have an impact on the patients who leave without being seen (LWBS) and on patient satisfaction, "Because the people who do need to be in the ED will be seen faster."
Some ED experts disagree, however. "While I'm not necessarily opposed to the concept, if the goal is to relieve crowding in the ED it will not help," asserts Michael Bishop, MD, CEO of Unity Physician Group, a Bloomington, IN-based emergency medicine urgent care physician group. "It has nothing to do with the 10%-20% of patients who present with nonemergent problems, because in general those patients are there not just because of a lack of access to a primary care provider, but for other social reasons — they don't have money, insurance, or transportation."
Those types of issues do not go away because a patient is talking to a TV screen instead of having a doctor physically there, he says. "If you don't have to pay [in an ED], nothing's cheaper," Bishop says.
Although he says that Health-e-Station's charges seem fairly reasonable, Agwunobi says they can go as high as $60 for the most complex visit.
Bruce Janiak, MD, FACEP, FAAP, professor of emergency medicine and an emergency physician at the Medical College of Georgia, Augusta, comes down somewhere in the middle. "Will it alleviate overcrowding? I'm not sure," he says. "It has to have some kind of positive effect, but it may take business away from doctors' offices as much as it will EDs."
What is the impact?
In terms of helping with LWBS rates and patient satisfaction, Janiak says Agwunobi "is right on the mark." How many patients it can effect is unclear, he concedes, "But we do know that time of throughput relates to satisfaction, and waiting for nonemergent care takes longer," Janiak says. What isn't known, he continues, is what percent of people are unwilling to wait three hours or more, rather than pay $30 or $40.
His summary of the technology? "Overall, I really encourage experimentation," he says.
Still, says Janiak, this may not be the most cost-effective application of telemedicine for EDs. "We know from studies that a lot of patients are sent from nursing homes to EDs because of a changing or perceived change in condition, and that at least half of them go back — which is another transport," he notes.
The latest study on cost, which is several years old, indicated each transport cost about $1,500, says Janiak.
"If you put up telemedicine in the nursing home and had an emergency physician talk to the people there about the patient, 50% of transports could be eliminated," he asserts. "You are talking about savings of tens of thousands of dollars a year, vs. the cost of a [personal computer]."
Sources/Resource
For more information on telemedicine's impact on the ED, contact:
- Andy Agwunobi, MD, MBA, Executive Vice President and Chief Operating Officer, St. Joseph Health System, Orange, CA. Phone: (714) 721-4067.
- Michael Bishop, MD, CEO, Unity Physician Group, Bloomington, IN. Phone: (812) 322-0151. E-mail: [email protected].
- Bruce Janiak, MD, FACEP, FAAP, Professor of Emergency Medicine, Medical College of Georgia, Augusta. Phone: (678) 852-1639.
For more information on Health-e-Station, go to: www.healthestation.com.
A newly opened telemedicine primary care facility in Peachtree City, GA, called Health-e-Station, will help curtail the severe overcrowding problems facing area EDs, according to its founder.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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