Breaking the Virtual Care Barrier

Stanford’s Virtual Visit Track (VVT) in the emergency department revolutionizes patient care, enabling remote consultation by board-certified emergency medicine physicians, resulting in shorter stays, satisfied patients, and fewer return visits. On a typical 8-hour shift, 15 patients are seen via Stanford VVT, and more than 4,000 patients have utilized the service.

On a recent 9 p.m. visit to the Stanford Hospital Marc and Laura Andreessen Adult Emergency Department (ED), 44-year-old Jane Dougherty presented with a cough, congestion, and high fevers. Despite the late hour, the lobby was full of waiting patients. As a lower-acuity patient, Jane faced a potentially long wait time to be placed in a traditional ED room to be seen by a physician.

However, because she met specific lower-acuity criteria, Jane was triaged to the Virtual Visit Track (VVT) and treated by a remote, board-certified telehealth emergency medicine physician. 

Jane was taken to a custom-designed telehealth area of the ED and connected by video to discuss her concerns and symptoms with Sam Shen, MD, professor of emergency medicine and one of the leads of the VVT project, who was based at a remote site. Shen guided an on-site ED technician, and nurse in facilitating a physical examination while he observed on a monitor. Based on his evaluation and diagnostic test results, Shen diagnosed a viral syndrome and determined the best next steps for care.

Jane was able to leave in less than an hour.

How it Works

In the VVT model, a remote board-certified emergency medicine physician serves as the telemedicine doctor and provides care to lower acuity patients who present at either the pediatric ED or the adult ED. These EDs experience surges at different times, and the VVT enables a single physician at a satellite location to “float” between the two.

The telemedicine physician is located at a remote site and utilizes virtual visit–enabling hardware and software to deliver ED care with support from the VVT-trained ED staff in the patient’s room. Telehealth physicians, nurses, and technicians are trained through a video series developed by Stanford emergency medicine physicians, with content geared to their unique roles. 

Stanford ED converted its existing Fast Track care unit into a VVT in 2020 in the middle of the COVID-19 pandemic surge and has since expanded the program. The VVT innovation helped garner Stanford Hospital a 2023 Davies Award of Excellence from the Healthcare Information and Management Systems Society.

Ryan Ribeira, MD, project co-lead notes while virtual care has advanced rapidly for other specialties, emergency medicine requires a more complex care approach and a steeper learning curve. “We are seeing an evolution in providing telehealth. Outpatient MDs have years of training and experience in telehealth, but this is new for EM doctors. Some telehealth tactics transfer but some don’t, and we’ve had to develop new ways to evaluate patients remotely. As our doctors treat more cases, they become more comfortable with their skills and available resources.”

Shorter Stays and Satisfied Patients

  • For Virtual Visit Track patients, Stanford researchers found the median ED length of stay was 1.9 hours compared with 4.2 hours for patients who received care through standard ED workflows after adjusting for acuity levels.
  • Over 80% of patients selected five out of five on their willingness to recommend the service.
  • 100% of VVT physicians rated their ability to deliver care on par with an in-person consultation as “excellent” or “very good.”
  • 6.7% of VVT patients returned to the ED within 72 hours following their initial visit versus 7.2% for patients experiencing


Future Innovations

First implemented in partnership with Meagan Moyer, MPH, RDN program manager for the Stanford Health Care Digital Healthcare Integration team, the program has been expanded to include Stanford’s off-site clinic staffed by emergency medicine attendings and ED staff. The program also offers scheduled video visits within 72 hours for patients discharged from the ED, when applicable. In the future, Stanford will explore providing low-acuity in-home telehealth care, and provide guidance via telehealth physicians to local EMS vehicles.


Updated Spring 2024