With ED visits declining, often due to fears of contagion or convenience, telemedicine has established a presence that’s unlikely to fade.

Data-driven strategies to capitalize on new opportunities and partnerships are valid options to create efficient and effective emergency care.

The 2020 pandemic year saw a sharp decline in emergency department visits, mostly in response to lockdowns and fear of contracting the virus. Alternative solutions that stepped in to fill the need — including virtual visits, urgent care centers, and specialty centers — are likely to remain.

A study by Transunion Health of more than 500 hospitals showed volumes down around 25% mid-pandemic. Those numbers have improved somewhat but are still not at pre-COVID levels. What was first seen as a necessity may now be seen as a convenience. Treatment of minor injuries, flu-like illnesses, infections, and the like probably will stay in the realm of intermediate care, meaning some ED patient volume will never return.

In the face of declining visits and revenues, how can EDs remain viable to provide important services to the community? Many are struggling to figure out what their new normal is, and how to adapt.

A value-based care perspective allows EDs to look at the big picture of caring for people at vulnerable points in their lives, and providing quality over quantity to reduce costs. Data-driven strategies can help create efficient and effective emergency care by capitalizing on new opportunities and partnerships.


Telemedicine has grown rapidly during the COVID-19 pandemic. The technology and infrastructure are in place, and it’s a modality that can work well in conjunction with the ED, expanding capabilities without expanding physical space or staff. In particular, telemedicine has been valuable in improving burn, trauma, and stroke transfer decisions in rural areas, and in providing specialties not available on-site.

EDs also are using telemedicine for remote triage and virtual follow-up visits. Adding billable telemedicine services and streamlining triage is beneficial to both patients and providers.

d2i is providing intelligence that helps clients realize the benefits of increasing efficiencies and adding billable services. By letting employees work smarter, not harder, teleservices of all types can have a positive effect on emergency operations.

Integrated Care Models

The Centers for Medicare & Medicaid Services (CMS) and The Joint Commission have long recognized the safety hazards that come along with care transitions, or handoffs from one care setting to another. Patients are especially vulnerable during handoffs from the ED to inpatient units. Poor handoffs cause increased length of stay and ED readmissions, and can cause preventable adverse health events.

Enter integrated acute care models. Groups that staff hospitals with an integrated team of emergency physicians and hospitalists are breaking down those silos and creating better care transitions. Safer, more efficient processes from a more-aligned team tackle the problem of decreasing ED revenues from a different perspective. By preventing adverse events and readmissions, and providing more efficient care overall, these groups save money and help build more streamlined operations.

One d2i client using a data-driven approach to coordinated care, Emergency Care Specialists, provides post-discharge care to substance abuse patients to reduce ED returns and readmissions, and to provide a valuable service to its community.

Another example of an innovative care model is the urgency room (UR) model designed by d2i data analytics client Emergency Physicians Professional Association (EPPA). The hospital’s UR center provides innovative care in a non-ED environment staffed by ED-trained professionals.

Care Partnerships

Emergency medicine as a specialty (rather than a destination) has an important part to play in creating better outcomes by aligning with other parts of the care continuum. One in four Medicare patients hospitalized for an acute illness is discharged to a skilled nursing facility (SNF). Of these patients, 23% end up back in the hospital within 30 days. Many factors contribute, including poor care transitions, increasing patient complexity, and tensions between facilities.

In an emerging care model, an ED physician’s expertise as a multidisciplinary team leader can improve the quality of care for SNF residents who need acute care. Such a model provides emergency care in the long-term care center as much as possible to avoid a transfer to the ED. Interventions like replacing PEG tubes, removing Foley catheters to prevent UTIs, managing tracheostomy complications, and starting IVs for medications and fluids can be highly effective in keeping residents in place and minimizing the risks introduced by hospitalization.

An innovative care model between SCP Health and Cornerstone at the Ranch SNF is showing great promise by providing 24/7 access to emergency mid-level practitioners and biweekly rounds by a hospitalist.

ED leaders are constantly facing new challenges, from pandemics to local disasters, and now to changing markets. To successfully navigate this latest challenge, they will need to be armed with the best data insights possible for informed decision-making. Contact d2i for data solutions that can give you the specialized operational plans and strategies to successfully create emergency medicine models for the future.