LAUSR

Study Objectives: The COVID-19 pandemic imposed both constraints and opportunities for innovation in emergency care delivery. Visits to the emergency department (ED) plunged by as much as 42% in the US, resulting in excess morbidity and mortality due to patients deferring or avoiding emergency care. With the declaration of a public health emergency, payors such as Medicare authorized emergency physicians (EPs) to bill for evaluation and management services delivered through telehealth—potentially allowing EPs to project emergency care beyond the four walls of the physical ED. If adopted, the provision of emergency care via telehealth could expand the reach of emergency medicine, not only during a pandemic but also more broadly, and especially as aging populations choose to receive more care at home. Such expansion of emergency care could benefit from perspectives of EPs in terms of the motivations, barriers, and necessary capabilities. Thus, our objectives were to survey and profile EPs to better understand the potential for telehealth in emergency care delivery. Methods: In collaboration with ACEP and the Emergency Medicine Practice Resource Network (EMPRN), we designed a survey instrument comprising of 5 main questions that provided ranked choice selections. The survey was sent electronically to a group of EMPRN volunteers representing EPs from diverse geographic, age, and practice levels. Results: The survey was sent to a total number of 765 participants, of which a total of 140 (18%) responded. In terms of motivations, respondents identified early engagement with the option to escalate care to the ED if necessary (77% ranked as very important or somewhat important). Respondents also identified the opportunity to quickly address non-life-threatening complaints that may not have needed an ED visit (76% ranked as very important or somewhat important). The top two identified barriers ranked as very significant or somewhat significant were the inability to obtain an adequate evaluation of the patient (76%) and a lack of support personnel in patients’ homes to assist with virtual visits (64%). A related series of responses ranked the needed capabilities necessary for supportive personnel to address barriers to telehealth use. (Table 1). Conclusions: This survey is a mechanism to begin understanding EPs’ perceptions and what they would need to feel comfortable to safely provide telehealth services in the ED. The results revealed that EPs recognize certain opportunities in terms of the potential future of telehealth in emergency care delivery. However, specific barriers were identified. This survey suggests that the ability to escalate care and obtain adequate telehealth exams with presenters and diagnostic support will be important for EPs to feel safe delivering telehealth services. [Formula presented]