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TeleEmergency Service at Dartmouth Health Expands

Analysis  |  By Christopher Cheney  
   October 07, 2022

The health system recently added its 12th participating hospital to the TeleEmergency service and plans to add another hospital soon.

Dartmouth Health is expanding its TeleEmergency service for hospitals in Northern New England.

Dartmouth Health launched its TeleEmergency service in 2016. The health system recently added Grace Cottage Family Health and Hospital in Townshend, Vermont, to the service, bringing the total number of participating hospitals to 12. Littleton Regional Hospital in Littleton, New Hampshire, is expected to be added to the service this fall.

The TeleEmergency service is organized with a hub at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire. The hub operates 24/7 with an emergency medicine physician and nurse on duty.

The hub has four stations that are essentially identical, says Kevin Curtis, MD, MS, medical director of Dartmouth Health Connected Care. The stations are hardwired with direct lines to all 12 of our participating hospitals' emergency departments. It does not require a cart and it does not require a transfer center. They call us directly, and we are instantly in the room by high-fidelity, live, interactive audio-visual technology."

Participating hospitals have telehealth technology in emergency department rooms, he says. "Each hospital has emergency department rooms that have monitors in a corner of the room, a computer below the monitor, and a camera that we can operate from the hub. The camera has zoom capability as well as pan-tilt. There is a microphone hanging from the ceiling of the room that can pick up audio from throughout the room. There is a button on the wall that anyone on the local team can press for a direct line to our hub."

There is a simple procedure for TeleEmergency calls, Curtis says. "If they want any help from us, a hospital staff member hits the button; and we answer the phone in the hub; we say, 'TeleEmergency, how can we help?' If it is Grace Cottage Hospital, for example, they will say, 'This is Grace Cottage Hospital. We would like some TeleEmergency help in Room 4.' Once we hear that, we call them up on live, interactive audio-visual technology, and we are 'in the room.' We think of ourselves as a doctor and a nurse who are walking into the room just like we were in the emergency department, and saying, 'How can we help?' We work collaboratively with the bedside team from that point forward."

Benefits for participating hospitals

The TeleEmergency service can help participating hospitals in several ways, Curtis says. "EDs are unpredictable in terms of volumes of patients, severity of patients, and complexity of patients. There can be sudden surges of patients. And the smaller the hospital, the less deep your staff bench is when a surge occurs. We have a system that can help the bedside team when there is a significant trauma, critically ill patient, or multiple patients at the same time—the kinds of situations where you would love to have an extra doctor and nurse."

The TeleEmergency service supplements the onsite bedside team, he says. "We can join the bedside team on demand whenever they want; and if we can be in the background as part of the team, the bedside team can spend more time focusing on patient care. Ultimately, our service may allow the patient to stay local and get their care at the local hospital."

The TeleEmergency nurse can help resuscitate a patient, Curtis says. "The ways in which we help include having our TeleEmergency nurse having oversight of a patient resuscitation in cardiac arrest. So, the bedside team is working on the resuscitation while we are overseeing the care—we can zoom in on the cardiac monitor. We can keep track of when it is time for the next medication or to stop CPR or start CPR. We can do all of that easily from afar."

The TeleEmergency team can facilitate a patient transfer if necessary, he says. "If despite us working together, the patient needs to be transferred elsewhere, we will help make that happen both by transport such as putting a DHART helicopter in the air or coordinating admission to the Dartmouth-Hitchcock Medical Center ICU or another facility. We can make all of that happen so that the bedside team can focus on the patient."

TeleEmergency financial model

The TeleEmergency service is financed by participating hospitals and Dartmouth Health, Curtis says. "The TeleEmergency service is first and foremost a mission-driven service not a revenue-generating service. Although each site that participates pays an annual fee to be part of the program, those fees do not offset the expense of having a 24/7 doctor and nurse in the hub. The TeleEmergency service and all of our Connected Care services are mission-driven from the health system to deliver outstanding services to the region regardless of where our patients are—we want to help patients and communities."

Dartmouth Health is committed to subsidizing the TeleEmergency service, he says. "The health system outlays money each year to continue this service because we are committed to the service and the benefit to patients."

The health system has also invested staff in the TeleEmergency service, Curtis says. "There is also a human investment—you need people to work in the hub. We are at the point now where we have physicians and nurses who enjoy doing the work. There are others who are interested in doing this work."

Related: Understanding the Value of a Hub-and-Spoke Telemedicine Program

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.


Dartmouth Health's TeleEmergency service operates on a hub model, with an emergency physician and nurse on duty 24/7 at Dartmouth-Hitchcock Medical Center.

The hub is hardwired with direct lines to all 12 of the TeleEmergency service's participating hospitals.

Benefits for participating hospitals include support during patient surges, help treating patients with complex conditions or traumatic injury, and stabilizing patients so they do not have to be transferred to larger hospitals.

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