Emergency rooms (ERs) in large cities in the United States often have too many patients. Many of these patients do not need urgent care and could be treated in other places. This overcrowding makes it hard for hospitals and doctors to do their jobs well. It also raises healthcare costs. One way to help is by using telemedicine with first responders to check patients quickly. The Emergency TeleHealth and Navigation (ETHAN) program in Houston, Texas, shows how technology can cut down on unnecessary ER visits, save money, and make emergency services work better.
Data from Harris County, where Houston is, show this problem clearly. About 40% of people who go to ERs in the county do not need urgent care. Some come for problems that a primary care doctor or clinic could treat. Many patients also do not have insurance or cannot pay. This makes it harder for hospitals to cover their costs. Harris Health System data say 61.5% of ER patients fall into this group.
This problem is common in many big cities across the U.S. Emergency services often get used for non-emergencies. Ambulance rides cost a lot, at least $1,000 each. Just walking into an ER adds about $1,500 in fees. These costs and many patients have made city leaders look for new ways to reduce ER crowding.
The Houston Fire Department started the ETHAN program in December 2022. The goal is to lower avoidable ER visits by using telemedicine. First responders still answer 911 calls as usual. But if they think it is not an emergency, they connect the patient to an emergency doctor by video. This live talk helps figure out how serious the problem is and where the patient should go for care.
Since it began, ETHAN has handled around 1,000 calls. The results include:
This program saved nearly $1 million in a few months by sending patients to cheaper places and avoiding unnecessary ambulance rides and ER stays.
Medical practice leaders in cities can see how telemedicine could help with ER overcrowding. Hospitals might work with or create telehealth triage systems to better use their resources.
Saving money is important. Ambulance trips cost at least $1,000, and ER visits add at least $1,500 more. Avoiding these for non-urgent cases helps hospitals spend money more wisely. It may also lower wait times in ERs and help doctors care for people with serious problems faster.
Also, sending patients to primary care helps manage long-term health and keeps people from going to the ER for simple problems.
Even with early success, ETHAN has challenges. A big one is not having enough doctors for telemedicine calls. The program cannot run after 10 p.m. because of this. Late at night, non-emergency calls still happen but get less help from the program.
Another issue is how people see 911. Many still use it for all health problems, emergency or not. This causes many calls and puts pressure on fire and EMS services. Alden Speer, an EMT with ETHAN, says non-emergency calls might be more than 40%. To change this, public education campaigns are needed along with the technology.
Artificial intelligence (AI) and workflow automation can improve programs like ETHAN. They help medical leaders and IT managers organize patient triage and resource use better.
AI can help during 911 calls by looking at symptoms, past data, and medical rules. AI tools that understand voice and language can help call takers spot non-emergencies quickly. This lets dispatchers send ambulances only when needed.
For doctors doing telemedicine, AI can suggest tests, treatments, and where patients should go for care based on the symptoms and data. This can help doctors avoid getting too tired and make their work faster and better.
Automation can also help coordinate EMS workers, telemedicine doctors, transportation, and follow-up care. Scheduling appointments, arranging taxi rides, and sending electronic messages to clinics can happen automatically. This reduces paperwork and speeds up care.
AI-based systems can follow how patients do after transport and treatment. This helps track how well the program works and find areas to fix. It also supports improving emergency response, using resources smartly, and community health efforts.
ETHAN is part of a change in emergency care. Laws like the Emergency Medical Treatment and Labor Act of 1986 and parts of the Affordable Care Act support using technology in healthcare.
The Emergency Medical Treatment and Labor Act says hospitals must treat all patients, even if they cannot pay. This adds strain to ER resources. Telemedicine programs that safely screen patients lower this strain by reducing unnecessary hospital visits.
Funding for ETHAN partly comes from the Affordable Care Act. This shows that the government sees the value of telehealth for cost-effective care.
Dr. David Persse, director of Emergency Medical Services for Houston Fire Department, said, “It’s unsustainable,” about ER crowding. Dr. Michael Gonzalez, ETHAN’s program director, said it is important to balance safety and new technology. He said, “We are at the intersection of ‘Can we safely triage that need?’ and the emerging technologies of ‘Right now, from anywhere.’”
First responders are concerned about many non-emergency calls. Alden Speer thinks the number is higher than reported. Dr. Kenneth Margolis worries this trend might make providers feel cynical.
These views show there is a big need for mixing telemedicine with existing emergency systems and educating the public about when to use the ER.
Telemedicine can help city health systems that face crowded ERs and high costs. By deciding patient needs during 911 calls and offering other options besides an ambulance or ER visit, programs like ETHAN show how technology can improve care while saving money.
As AI and automation get better, they will likely help make patient checks more accurate, workflows smoother, and coordination better in emergency care. Healthcare leaders looking into these tools will have to handle challenges like staffing, patient trust, and data safety.
The experience with Houston’s ETHAN program gives lessons that other cities in the U.S. can use to make emergency care systems work better for both patients and providers.
ETHAN, or Emergency TeleHealth and Navigation, aims to reduce avoidable emergency room visits by allowing first responders to consult with an emergency physician via telemedicine at the scene, assessing if the situation is truly an emergency.
The program has saved the city around $1 million by prioritizing non-emergency care, allowing less expensive transportation options like cabs instead of costly ambulance rides for patients who do not require emergency services.
Studies indicate that approximately 40% of patients visiting Houston’s ERs do not need emergency care and could be treated by primary care physicians or clinics.
If a patient is deemed not to have an emergency, the ETHAN doctor can schedule a non-emergency appointment and arrange for city-paid cab transport instead of an ambulance.
Since launching, the ETHAN program has resulted in about 1,000 calls, with 20% leading to emergency room visits, 45% transported by cab, and 35% receiving care instructions at home.
The program struggles with a shortage of doctors available for telemedicine consultations, and it is unavailable after 10 p.m., which limits its capacity during night hours.
Many patients now use 911 calls to access emergency rooms rather than as a last resort, leading to congested ERs with many non-urgent cases.
The idea stemmed from the recognition of a broken system where emergency rooms were becoming the primary care avenue for many non-urgent health issues.
Patients are contacted by public health nurses or counselors for follow-up home visits, ensuring they have a doctor and keeping their scheduled appointments.
Funding comes from a provision of the Affordable Care Act that supports programs utilizing technology to deliver more efficient and cost-effective healthcare.
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