Staff buy-in key to reducing ED visits with telemedicine, senior living study

An attempt to reduce unnecessary emergency department visits with telemedicine triage failed when senior living healthcare providers were not on board, a new study has found. There’s a lesson for clinicians and administrators from the findings, the researchers say.

The intervention was conducted in a 950-bed independent living community in California. When a resident called for help, an emergency medical technician could contact an emergency medicine physician via telemedicine to assist with management and triage. Facility administrators encouraged staff members to use the program even in cases that were not medically urgent, and there was no cost to residents.

The researchers, including long-term care expert David Grabowski, Ph.D., of Harvard, compared the number of calls that resulted in emergency department transport with the same outcomes in two control communities.

Intervention uptake was low, with no reduction in emergency department visits. What’s more, investigators found a great divide in resident and staff perception of the program. Many residents found it helpful, and some said it helped them avoid unnecessary emergency care. But in focus groups, EMT-trained staff said residents were reluctant to use the telemedicine option and did not directly request it. In addition, they believed that the process simply delayed an inevitable hospital trip and that it was an obstacle to providing proper care.

“Staff were saying it’s not appropriate for emergency care, and most folks need to go to the emergency room,” said co-author Kelsi Carolan, LCSW, of the University of Connecticut. She and her colleagues concluded that any changes to this dynamic would require a cultural shift among workers who are trained to use emergency care to help their patients, and are understandably invested in this mode of healthcare.

“There’s room for change if there is increased recognition among these frontline providers that sending people to the emergency room unnecessarily is not actually helping them and may actually cause harm,” Carolan said. 

The pandemic may have helped do just that, she added. “There might be a broader and more mainstream understanding now of the risks, at least related to COVID, of going into the emergency room when it’s not necessary,” she said.

The takeaway for clinicians? There can be such a big discrepancy between the preferences of the people being served by providers and what the providers believe is best, Carolan said. 

And for administrators, “if the people on the ground who are actually in charge of delivering the intervention don’t feel it is valuable or a good use of their time, then the whole thing may be destined to fail. For me, that encourages caution,” she concluded.

The study was published in the Journal of Medical Internet Research.