Virtual Visits in the Emergency Department

Stanford Hospital Emergency Department’s Virtual Visit Track (VVT) has been recognized as an exceptional model for leveraging information and technology to elevate patient safety, care quality, and operational efficiency. 

The VVT innovation helped garner Stanford Hospital a 2023 Davies Award of Excellence from the Healthcare Information and Management Systems Society.

How the Virtual Visit Track Works

Stanford's Emergency Department (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.

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 who are 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. 

Read more about how the VVT works in a recent New England Journal of Medicine study.

Patient Satisfaction and Length of Stay

On a typical 8-hour shift, 12.5 patients are seen in the VVT. Since its inception, more than 4,000 patients have utilized the service.

"Overall we are seeing shorter lengths of stay, satisfied patients and physicians, and fewer return visits," notes Dr. Sam Shen, one of the physicians leading the project.  For VVT patients, Stanford Emergency Medicine physician researchers found the median ED length of stay for VVT patients was 1.9 hours compared with 4.2 hours for patients who received care through standard ED workflows after adjusting for acuity levels.

Additional findings:

• Over 80% of patients polled selected five out of five on a 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 standard care workflows. 

Project co-lead Ryan Ribeira, MD notes while virtual care has advanced rapidly for other specialties, emergency medicine requires a more complex approach and a steeper learning curve.

“We are seeing an evolution in emergency medicine physicians’ comfort 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.”