Leveraging Telemedicine to Reduce ED Overcrowding: The Quirónsalud Virtual Urgent Care Program

SummaryThe Quirónsalud Virtual Urgent Care Program leverages telemedicine in the ED setting to reduce ED overcrowding by decreasing potentially avoidable visits, clinical burden, and ED wait times. Using a two-pronged approach, the program gives off-site, home-based patients considering an ED visit access to on-demand remote care, while also providing support to on-site ED staff through an ED-based virtual visit service, attending selected low-acuity patients who present with qualifying symptoms via videoconference. Since its launch in March 2021 through April 2023, the program has provided care for more than 45,000 patients, currently attending 14%–16% of the outpatient ED workload daily and has reduced avoidable ED visits by 7,362. From January 1, 2022, to October 25, 2022, the network’s four EDs have received a total of 501,777 on-site visits; the Virtual Urgent Care Program accounted for 21,661 patient visits, which includes 17,697 (3.53%) of the on-site ED patients who were directed to on-site virtual care and 3,964 off-site patients who registered directly for virtual care. Of the 3,964 patients receiving off-site, home-based virtual urgent care during this period, only 250 (6.31%) were referred to the ED for emergent care. Thus, 3,714 ED visits were avoided from this group. Of the 17,697 patients who received urgent care via the ED-based virtual visit circuit, only 2,441 (13.79%) were referred from the videoconference suite for subsequent assessment by an on-site ED physician. Thus, another 15,256 standard ED visits were avoided from the on-site group. Matched cohort analysis showed that the program was associated with a 59-minute reduction in overall length of stay (86 minutes vs. 145 minutes; 95% confidence interval [CI], −61.65 to −57.31; P ≤ 0.0001). Mean overall stay for ED-based virtual urgent care patients is currently 1.92 hours, compared with 4.45 hours for low-acuity ED patients (95% CI, −161.41 to −141.75; P ≤ 0.0001) and 5.7 hours for all ED patients (95% CI, −236.31 to −217.51; P ≤ 0.0001). The program’s 72-hour ED readmission rate is less than 1% for both the on-site, ED-based patients and the off-site, home-based virtual care patients. Patients reported a mean Net Promoter Score of 61.62, more than 18 points higher than that of patients receiving standard ED care (42.74; 95% CI, 13.37–24.39; P ≤ 0.0001). The authors encourage networks facing the challenge of ED overcrowding to assess the option of leveraging telemedicine as a valuable tool in addressing avoidable ED visits.