TOPLINE:

Tele-emergency care (TEC) was associated with an approximately 37% reduction in emergency department (ED) visits within 7 days among veterans requiring urgent or emergent evaluation, according to a new cohort study. The reduction was greatest in higher-acuity cases.

METHODOLOGY:

• A retrospective cohort study included more than 2.5 million calls made to a nurse advice line by 719,028 veterans (mean age, 62.3 years; 87.3% men) who were triaged to require evaluation within 8 hours in the US Veterans Health Administration from 2018 to 2024.
• The calls were triaged as urgent (veterans were recommended clinical evaluation within 2-8 hours), emergent (veterans were recommended clinical evaluation within 2 hours), or emergent 911 (veterans were advised to call 911 but they declined).
• A total of 94,674 calls involving TEC were included.
• Researchers compared outcomes between individuals who received TEC and those who did not. The primary outcome was ED use within 7 days of the first call; secondary outcomes included hospitalization within 7 days and 30-day mortality.
• The analysis was adjusted for triage acuity, chief concern, veterans' demographic and clinical characteristics, rurality, prior ED use, and call timing.

TAKEAWAY:

• Use of TEC was associated with a 36.6% relative reduction in ED visits within 7 days compared with no use of TEC (P < .001).
• The association was strongest for emergent calls (average treatment effect [ATE], -22.0%; 95% CI, -24.1% to -19.9%) and emergent 911 calls (ATE, -19.3%; 95% CI, -21.9% to -16.6%) and more modest for urgent calls (ATE, -5.6%; 95% CI, -8.4% to -2.9%).
• Use of TEC was associated with lower hospitalization rates overall (ATE, -2.1%; 95% CI, -2.4% to -1.8%), with larger reductions among emergent 911 calls (ATE, -5.1%; 95% CI, -6.2% to -4.1%) and emergent calls (ATE, -2.6%; 95% CI, -2.9% to -2.2%). No association was found between TEC use and 30-day mortality.
• Facility-level TEC implementation was associated with a smaller reduction in ED use, with statistical significance observed only for emergent calls. Hospitalization and mortality rates did not differ by TEC modality (phone vs video) or clinician type (physician vs advanced practice clinician).

IN PRACTICE:

"These findings suggest that TEC represents a scalable approach to extending emergency care expertise beyond the walls of the ED while preserving in-person capacity for patients who need it most," the authors wrote.

"Broader implementation of tele-emergency care could be a solution for health systems seeking to mitigate emergency department crowding while addressing patients' acute care needs," they added.

SOURCE:

The study was led by Kathleen Yinran Li, MD, MS, University of Washington School of Medicine, Seattle. It was published online on April 6, 2026, in JAMA Network Open.

LIMITATIONS:

The study was limited by residual confounding, varied and staggered implementation of TEC across sites, lack of inclusion of care reimbursed by insurers other than Department of Veterans Affairs, and lack of measurement of internet access. Additionally, patient experience or overall reach were not evaluated in the study.

DISCLOSURES:

The study was funded by the Emergency Medicine Foundation and the Veterans Affairs Quality Enhancement Research Initiative. Several authors reported receiving grants from various sources. Details are provided in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.