A new case study has been released in NEJM Catalyst, indicating minimal differences in the quality of virtual care given to patients considered ‘low-acuity’ from the emergency department in Stanford Health Care and of standard health care workflows provided in person.
The college made the decision to speed up the implementation of its strategy to incorporate virtual visits into clinical care in December 2020. The choice was made in efforts to mitigate the overwhelming COVID-19 pandemic-related delays in healthcare delivery. Stanford accelerated the process by adjusting its ED Fast Track, implementing a new format named ‘Virtual Visit Track’. According to the NEJM Catalyst case study, a low-acuity patient generally faces longer wait times in an ED as higher-acuity patients are given priority. Stanford Health Care responded to this by establishing the Fast Track unit, which is made up of medical professionals, nurses, and emergency department personnel, to address this problem. In response to a significant increase in COVID-19 cases, both Stanford’s adult and pediatric EDs switched from the Fast Track to the Virtual Visit Track (VVT). In the VVT, a lone doctor in a satellite site uses telehealth to assess low-acuity ED patients and on-site advice is provided by support personnel with VVT training to aid the physician.
Following the first year of the program’s implementation, it was found that approximately 2300 patients received care. Additionally, there has been a consistent patient volume of 12 patients seen during an eight-hour shift through the VVT since around seven months following the introduction of the program. The median ED length of stay for VVT patients was 1.9 hours, which is notably lower than the 4.2 hours for patients who received care via normal ED workflows, according to an analysis of the care given through the VVT. Sixty six percent of VVT doctors stated their ability to provide care of an equal standard to in person workflows was ‘very good’ in rating, while thirty-four rated it as ‘excellent’.
Overall, the data indicates that VVT visit quality is on par with conventional care processes for low-acuity patients, despite the difference in rate within the data not being significant statistically. In comparison to patients receiving standard care procedures, the median rate of return within 72 hours of the initial ED visit was 6.7 percent for VVT patients as opposed to 7.2 percent. Similar to this, patients with VVT had a median return visit rate of 10.4% as opposed to 12.4% for patients with conventional care workflow, making them marginally less likely to attend the ED again within seven days.