Tele-emergency care reduces emergency department visits
Among veterans triaged as needing urgent evaluation, tele-emergency care was linked to fewer emergency department visits without higher death rates.
*Retrospective cohort study; Level 2b (OCEBM).

Citation

Li KY, Tran LD, Rose L, Ferguson JM, Urech TH, Engstrom Buggaveeti A, Vashi AA. Acute Care Use and Mortality by Tele-Emergency Care Use, Modality, and Clinician Type. JAMA Network Open. 2026;9(4):e265406. doi:10.1001/jamanetworkopen.2026.5406

Background

Emergency department crowding is common, and nurse advice lines often err toward sending patients to the emergency department. Tele-emergency care adds a real-time virtual visit with an emergency clinician to refine next-step decisions.

Patients

719,028 United States veterans making 2,511,932 nurse advice line calls (Jan 2018–Apr 2024), during weekdays 8 AM–6 PM, triaged as needing clinician evaluation within 8 hours. Excluded: less-urgent triage, missing key baseline data, and certain sites/workflows not addressing higher-acuity concerns.

Intervention

Tele-emergency care visit (phone or video; physician or advanced practice clinician).

Control

Usual nurse advice line triage without tele-emergency care.

Outcome

(Primary) Emergency department visit within 7 days; (Secondary) hospitalization within 7 days; death within 30 days.

Follow-up Period

7 days (use), 30 days (death).

Results

Outcome (tele-emergency care vs usual care) Absolute difference Approx. visits needed to prevent one event
Emergency department visit within 7 days (primary) 28.5% vs 45.0% (−16.5%) ~6
Hospitalization within 7 days −2.1% ~48
Effects were larger for higher-acuity calls (emergent: −22.0% emergency department visits; ~5 needed to prevent one visit). Death within 30 days did not differ. Differences by phone vs video and by clinician type were small; facility-wide rollout was linked to only a small emergency department reduction (−2.6%) for emergent calls.

Limitations

Observational design may leave unmeasured differences between groups. Results may not generalize beyond mostly older male veterans and business hours. Some non–Veterans Affairs care may be missed. Facility-level impact was modest, likely due to low uptake.

Funding

Emergency Medicine Foundation; Veterans Affairs Quality Enhancement Research Initiative.

Clinical Application

Consider tele-emergency care after nurse triage to reduce emergency department use, especially for higher-acuity calls, without apparent short-term harm; prioritize improving program uptake.