3EMF Telemedicine Facilitation of Transfer Coordination from Emergency Departments

Abstract Objective Inter-hospital transfers are costly to patients and to the healthcare system. The use of telemedicine may enable more efficient systems by decreasing transfers or diverting transfers from crowded referral emergency departments (ED) to alternative appropriate facilities. Our primary objective was to describe the prevalence of telemedicine for transfer coordination among US EDs, the ways in which it is used, and characteristics of EDs that use telemedicine for transfer coordination. Methods We used the 2016 National Emergency Department Inventory (NEDI)-USA survey to identify telemedicine-using EDs. We then surveyed all EDs using telemedicine for transfer coordination and a sample of EDs using telemedicine for other clinical applications. We used a multivariable logistic regression model to identify characteristics independently associated with use of telemedicine for transfer coordination. Results Of the 5,375 EDs open in 2016, 4,507 responded to NEDI-USA (84%). Only 146 EDs used telemedicine for transfer coordination; of these 79 (54%) used telemedicine to assist with clinical care for local admission, 117 (80%) to assist with care prior to transfer, and 92 (63%) for arranging transfer to a different hospital. Among telemedicine-using EDs, rural (OR=3.32, 95% CI 1.79-6.16) and Midwest location (OR=3.45, 95% CI 1.50-7.94) were independently associated with use of telemedicine for transfer coordination. Conclusions Though telemedicine has potential to improve efficiency of regional emergency care systems, it is infrequently used for coordination of transfer between EDs. When used, it is most often to assist with clinical care prior to transfer.