In the pilot study, which received UCSD's institutional review board approval, all patients were also seen by the on-site ED physician before being ultimately released home—a safety net to catch mistakes.
So what could go wrong? "All of the things you might imagine," Guss says. "Perhaps we are more prone to misdiagnosis and miscommunication. I don't have any evidence that's occurred. And though we're talking about a pretty small number of patients at this point, the preliminary results are encouraging."
Guss and his co-investigators at UCSD hope to present their results at the October meeting of the American College of Emergency Physicians, and asked me not to publish the data because it's premature.
But suffice it to say that the telemedicine physician, the ED physician and the RN all received scores higher than 3 from the participants. Best of all, he says, the average length of ED wait for those telemedicine patients was about half the current 296 minutes posted on Hospital Compare.
Guss hopes to eventually analyze the impact of ED telemedicine on the department's bottom line. It may reduce or avoid ED physician services payments or increase revenue because more ED patients would be treated.
Then, he hopes to expand the ED telemedicine to multiple sites across the country, at non-academic community hospitals in large cities and at small rural areas to test the concept further on a large scale.
Guss is optimistic. "So far, the patients love it because they actually feel like they're getting more attention (from the telemedicine doctor), not less. They don't see us in the flesh, but they get more face time."