Tele-Observation: Using Telemedicine to Centralize Observation Care Across Multiple Hospitals

George Hughes, MD
Attending Physician
Assistant Professor, Emory University Department of Emergency Medicine
Assistant Medical Director, Emergency Department
Medical Director, Clinical Decision/Observation Unit
Emory University Hospital

Telemedicine is an exciting frontier for medicine, as well as an area targeted by ACEP for growth and training of its members. It possesses the ability to extend the reach of patient care well beyond its previous utilization, connecting under-resourced regions of the country. Covid-19 has only sped up the use of telemedicine in areas previously not realized, including within observation care.

Tele-observation allows for the centralization of observation care to a single physician across multiple hospitals. Through this technology, hospitals that previously did not have the patient volume to support a full observation unit may now be able to combine with other hospitals in the system to create a larger “unit”. Additionally, it could be used to keep patients at satellite or rural emergency departments, continue their observation protocol-driven care with the oversight of the tele-observation team, and lower the cost and burden of transferring patients to larger hospital centers. These are just a few of the numerous ways that telemedicine and observation care could be combined to fit the needs of your hospital system and its patients.

For the past two years, the Emory Department of Emergency Medicine has been using telemedicine to provide observation care. We have created a combined unit of 29 beds from two hospitals in our system and centralized rounds/care to a single physician. It has allowed focused care for patients by the observation physician without further work responsibilities. Initial data has shown that cost, observation length of stay, and patient care has not been compromised and has been equivalent to in-person care. We believe that it continues to provide great care for patients and are looking for ways to expand our observation footprint using telemedicine.