Building a Virtual Care Model for Emergency Medicine

In many emergency departments, crowding reflects sustained system constraints rather than temporary surges. Lower-acuity patients often wait alongside higher-acuity cases, not because their conditions are complex, but because room availability and staffing determine throughput.

Telehealth has expanded rapidly in outpatient medicine. Its integration into the emergency department, however, requires adaptation to the pace, acuity, and diagnostic demands of acute care.

Stanford Emergency Medicine developed the Virtual Visit Track (VVT) to evaluate whether remote, board-certified emergency physicians could be embedded directly into ED workflows for selected lower-acuity patients.

On a typical eight-hour shift, approximately 15 patients are evaluated through the VVT. Since implementation, more than 4,000 patients have received care through the model.

The Virtual Visit Track Model

The Virtual Visit Track enables a remote emergency physician to evaluate lower-acuity patients in either the adult or pediatric emergency department. Because peak demand differs between sites, a single physician can “float” virtually between them via video monitors.

Patients who meet defined triage criteria are brought to a dedicated telehealth space within the ED and connected through secure video technology.

The consulting physician conducts the virtual evaluation while on-site nurses and technicians facilitate components of the physical examination and coordinate diagnostic testing. The remote physician directs the encounter in real time and determines next steps for care.

Stanford converted its former Fast Track unit into the Virtual Visit Track in 2020 during the COVID-19 surge. The model later received a 2023 Davies Award of Excellence from the Healthcare Information and Management Systems Society.

Although telehealth has advanced rapidly in outpatient medicine, its application in emergency care requires modification. Some virtual evaluation techniques transfer directly, while others must be adapted to accommodate the pace, acuity, and diagnostic complexity of the emergency department. Experience within the VVT model has informed ongoing refinements in workflow and clinical assessment.

Virtual Visit Track Outcomes

Stanford researchers compared outcomes for VVT patients with those receiving standard ED care.

Findings include:

• Median ED length of stay of 1.9 hours for VVT patients versus 4.2 hours for standard workflows, adjusted for acuity

• More than 80 percent of patients rated their willingness to recommend the service as five out of five

• 100 percent of participating physicians rated their ability to deliver care virtually as “excellent” or “very good”

• 6.7 percent of VVT patients returned within 72 hours compared with 7.2 percent in standard workflows

These results suggest that, for selected patients, virtual evaluation can be incorporated into emergency department operations without increasing short-term return visits and with reduced overall length of stay.

Ongoing Development

The model has expanded to include an off-site clinic staffed by emergency medicine attendings and ED personnel. Scheduled video follow-up visits within 72 hours are available for selected discharged patients.

Additional areas under evaluation include low-acuity in-home telehealth care and remote physician support for local EMS teams.

The Virtual Visit Track represents an ongoing effort to assess how telehealth can support emergency department capacity while maintaining clinical oversight and patient safety.

The VVT initiative was developed under the leadership of Sam Shen, MD and Ryan Ribeira, MD, in partnership with Meagan Moyer, MPH, RDN, program manager for Stanford Health Care’s Digital Healthcare Integration team.

Updated February 2026