Telemedicine may provide cost-effective ED triage option for pediatric orthopedic trauma
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Key takeaways:
- Results showed telemedicine consultation prior to ED transfer was more cost-effective than transferring everyone.
- Telemedicine was only less cost-effective if a high proportion of patients required transfers.
Peer-to-peer telemedicine consultations may be a cost-effective triage strategy prior to ambulance transfer to the ED for pediatric patients with orthopedic trauma, according to published results.
“This research demonstrates how telemedicine can serve as a pathway to providing cost-effective, high-quality care in pediatric orthopedics,” the researchers wrote in the study published in the Journal of the American Academy of Orthopaedic Surgeons.
Researchers retrospectively categorized 350 pediatric patients with orthopedic trauma into three groups based on whether they could have been optimally treated with urgent ED-level care and ambulance transport (group 1), ED-level care without ambulance transport (group 2) or no acute medical or procedural treatment (group 3). Utilizing a decision tree, researchers evaluated the expected costs per patient based on whether all patients were transferred using an ambulance or if the decision to transfer occurred after telemedicine consultation.
Researchers found the telemedicine triage strategy cost $4,858 per patient compared with $6,610 per patient in the transfer-all strategy. In addition, researchers found the proportion of patients requiring ambulance transport in group 2 would need to exceed 98.2% for the transfer-all strategy to be preferred to the telemedicine triage strategy.
Results showed the telemedicine triage strategy had a stable cost-savings advantage across a wide range of values for pertinent variables. Even if the telemedicine visit cost $1,000, as long as the proportion of patients in group 2 requiring ambulance transport did not exceed 85%, the telemedicine triage strategy remained cheaper than the transfer-all strategy, according to researchers.
“Implementation of peer-to-peer telehealth consultation platforms should be strongly considered for hospital systems that frequently transfer patients between sites or send/accept ED-to-ED transfers,” the researchers wrote. “Future research and administrative resources should focus on effective implementation of similar models in the setting of concerns related to provider availability, reimbursement, liability and startup costs.”
Perspective
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Arlene R. Maheu, BS, and colleagues should be commended for applying a rigorous financial model to a common scenario we all face: unnecessary emergency room transfers. As expected, a telemedicine-triage strategy was more cost-effective than a “transfer-all” strategy, even when indirect costs, such as family time/expense, were not included. Studies such as this will become more important as the need to demonstrate value (quality/cost) only continues to increase in health care’s resource-constrained environment.
However, this issue is complex with multiple stakeholders, including health care systems, third-party payers, heath care providers and patients/families, that may have different incentives. Implementation of these strategies will vary, as the authors note, between institutions/providers based on resources available locally. The details surrounding the implementation of a virtual triage system, including the role, responsibilities and reimbursement of the pediatric orthopedic surgeon, are essential for delivering safe high-quality care.
As we continue to study and implement cost-minimization strategies, which are important, it is critical that we remember that the primary outcome should always be obtaining the best and safest possible outcome for our patients, regardless of cost.
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