Telemedicine-Based Emergency Physician Assessment Prior to ED Entry: A Randomized Controlled Trial

Randomized Controlled Trial Comparing the Safety and Efficiency of a Virtual-Hybrid Emergency Department Model Versus Standard Emergency Department Management in Non-Urgent Patients

Background:

Emergency department (ED) overcrowding is a growing challenge worldwide and is associated with prolonged length of stay (LOS), reduced patient satisfaction, and increased burden on healthcare systems. New approaches are needed to improve how patients are evaluated and treated.

Telemedicine has been increasingly integrated into ED care and has shown feasibility and benefits in various settings. Existing models have demonstrated improvements in patient flow, reduced length of stay, and high patient satisfaction. However, despite the growing use of telemedicine in emergency medicine, there is a lack of randomized controlled trials evaluating its effectiveness and safety, particularly in models involving early remote physician assessment prior to ED evaluation.

Purpose:

This study aims to evaluate whether a video consultation with a senior emergency physician before entering the ED can improve the efficiency and quality of care. The study also examines whether physicians can accurately identify which patients need ED evaluation based on a remote assessment, while maintaining patient safety.

Methods:

A total of 200 adults who arrived at the ED were assigned to one of two groups. In the study group, participants had a video consultation with a physician before continuing with standard ED care.

In the control group, participants received standard ED care only.

During the video consultation, the physician performed an initial clinical assessment and could order tests or specialist consultations. The physician was also asked what their recommendation would have been if the participant had been assessed from home. Three possible decisions were recorded:

• Immediate ED presentation
• Scheduled ED presentation at a later time
• Continued care in the community without ED presentation

Outcomes:

The primary outcomes focus on the effectiveness of the intervention. These include:

• ED length of stay
• Patient satisfaction
• The ability of physicians to accurately identify participants who require ED evaluation The secondary outcome is safety, assessed by return visits to the ED within one week for the same complaint.

Study Overview

• Status: Completed
• Conditions: Telemedicine; Emergency Care; Emergency Department Crowding
• Intervention / Treatment: Behavioral: Telemedicine-Based Remote Physician Assessment

• Study Type: Interventional
• Enrollment (Actual): 200
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Israel
  • Ramat Gan, Israel
    • Sheba Medical Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Adults aged 18 years and older
• Presentation to the emergency department during study recruitment hours
• Ability to provide written informed consent

Exclusion Criteria:

• Pregnancy
• Arrival by ambulance
• Severe pain, defined as a Visual Analogue Scale (VAS) score of 8 or higher
• Emergency Severity Index (ESI) level 1 or 2
• Language barriers or technological difficulties without an accompanying person able to assist
• Isolated orthopedic complaints with suspected fracture or dislocation
• Repeat emergency department visit for the same complaint within the previous 72 hours

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Study Group / Telemedicine Group; Participants undergo an initial video consultation with a senior emergency physician prior to continuing with standard emergency department care.	Behavioral: Telemedicine-Based Remote Physician Assessment; Participants undergo an initial video consultation with a senior emergency physician prior to continuing with standard emergency department care. The consultation includes a clinical assessment and may involve ordering diagnostic tests or specialist consultations.
No Intervention: Control Group; Participants receive standard emergency department care without a prior video consultation.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Emergency Department Length of Stay	Emergency department length of stay, defined as the time from emergency department registration to discharge or hospital admission during the index visit, measured in hours. Data will be extracted from the hospital electronic medical record one week after the visit.	From emergency department registration to the final decision regarding discharge or hospital admission during the index visit, up to 24 hours.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Return Visits to the Emergency Department	Return visits to the emergency department within one week for the same complaint.	Within one week after the ED visit
Accuracy of Physician Assessment for ED Referral	The ability of physicians to identify participants requiring emergency department evaluation based on the initial video consultation, assessed by comparing physician recommendations to actual clinical outcomes.	From the baseline physician assessment at the initial video consultation, to the final clinical outcome at the end of the index visit (discharge or hospital admission), up to 24 hours.
Patient Satisfaction	Patient satisfaction will be assessed using the Short Assessment of Patient Satisfaction (SAPS) questionnaire, administered via SMS one week after the emergency department visit. The SAPS is a validated 7-item questionnaire that assesses multiple aspects of patient satisfaction. Total scores range from 0 to 28, with higher scores indicating greater patient satisfaction. Scores of 0 to 10 indicate Very dissatisfaction, 11 to 18 indicate dissatisfaction, 19 to 26 indicate satisfaction, and 27 to 28 indicate very high satisfaction.	One week after the ED visit

Collaborators and Investigators

• Sponsor: Sheba Medical Center

Study record dates

Study Major Dates

• Study Start (Actual): November 18, 2025
• Primary Completion (Actual): January 31, 2026
• Study Completion (Actual): January 31, 2026

Study Registration Dates

• First Submitted: April 5, 2026
• First Submitted That Met QC Criteria: April 19, 2026
• First Posted (Actual): April 22, 2026

Study Record Updates

• Last Update Posted (Actual): May 7, 2026
• Last Update Submitted That Met QC Criteria: April 30, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Other Study ID Numbers: SMC-2688-25

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No