The Under-an-Hour Emergency Room Visit

Imagine going to the emergency department of your local hospital late one Saturday night — you know you’re sick, and what you have in your medicine cabinet is just not enough to give you any relief.

You’ll probably endure a multi-hour wait before you are seen by a very busy emergency room physician. Among the factors contributing to the bottleneck? The 20 percent of Americans who use the emergency department (ED) for their routine healthcare needs each year, according to the Centers for Disease Control and Prevention.

“We hear it all the time — waiting creates real frustration and anxiety for patients,” says Dr. Rahul Sharma, the emergency physician-in-chief at NewYork-Presbyterian/Weill Cornell Medical Center. “Typically, when a patient comes into the ED, the entire process, including triage — where the acuity, or seriousness, of the problem is assessed — a physician assessment and checking out can range from a total of two to five hours.”

This problem, says Dr. Sharma, was the genesis for Digital ED Express Care Service, launched at NewYork-Presbyterian/Weill Cornell Medical Center in July. The service is a telehealth initiative that’s transforming the emergency care experience for both patients and doctors, drastically reducing wait times and stress without sacrificing quality.

“It’s the first ED-based telehealth program using this model in the country,” says Dr. Sharma. “No one else has done telehealth like this — you get checked out, you have a screening exam by a nurse practitioner or physician assistant and then you get discharged directly from the room, typically in less than one hour.”

All ED patients go through triage, when a physician assistant or a nurse practitioner performs a medical screening exam. Those who are judged to be in stable condition with no life-threatening injuries or symptoms are given the option of seeing an emergency room physician via a videoconference in a private room.

“All express care patients get the same initial screening as all emergency room patients. Then, after that, they get immediate one-on-one time with a NewYork-Presbyterian physician, in addition to a follow-up call from of our registered nurses,” says Dr. Sharma.

Average time from check-in to checkout is 30 to 40 minutes. That sounds impossibly quick until you realize that the program is meant only for patients with minor complaints. As a result, doctors and nurses are now able to see the sickest patients sooner, says Dr. Sharma, who emphasizes that Digital Express Care is for patients with mild complaints — flu-like symptoms, minor cuts, a sprain — rather than for more serious issues such as chest or abdominal pain or life-threatening trauma.

“The point is not to just to have patients in and out sooner. Every patient is important and we must ensure that they all receive the highest quality care,” says Dr. Sharma. “But for the ones who are not particularly ill, it’s a great option. Patients tell us that it feels like something out of The Jetsons. They’re ecstatic about it.”

Digital Express Care began in July 2016 by covering the ED four hours a day. Now, it is available 16 hours a day, from 8 a.m. to midnight all week, and has expanded to cover NewYork-Presbyterian Lower Manhattan Hospital as well.

In November, Donald Russo came into the ED as a result of a head injury. For his initial visit, he went through the traditional pathway and was seen by several providers and received stitches. This visit lasted about 90 minutes, and he was advised to come back in 10 days to have his stitches evaluated. When Russo returned as instructed, he was offered the Digital Express Care service and decided to take advantage of it.

“I was very impressed with the whole experience,” he says. “The doctor was able to check the stitches and answer my questions. The technology is pretty unbelievable.”

“And I actually went back there for a follow-up a week later,” he says, “and asked if I could use Digital Express Care again.”

That kind of patient experience is one reason hospitals throughout the country are calling NewYork-Presbyterian to find out how they can replicate the results.

“I like to tell people that this is an example of patients driving care,” says Dr. Sharma. “They’ve created the demand for more innovative health care delivery. Over a dozen other health care systems have contacted us to learn about the service.”

Ultimately, though, Digital Express Care isn’t simply about speed or the ability to talk to a doctor on a flat screen or a phone.

“More and more patients are coming to the ED, so we have to offer alternatives to the way they receive care,” says Dr. Sharma. “While it’s important to provide efficient care, we should never compromise on quality.”