Veterans Who Receive VA Tele-Emergency Care Have Fewer Emergency Department Visits within 7 Days

BACKGROUND:
Emergency department (ED) crowding contributes to care delays, adverse patient outcomes, and provider burnout. Tele-emergency care (TEC) enables real-time virtual encounters with emergency clinicians following triage by the VA nurse advice line, offering Veterans timely access to emergency medicine expertise without requiring an in-person ED visit. In this national evaluation, investigators reviewed calls to the VA nurse advice line from January 2018 through April 2024 to examine associations between TEC receipt, visit modality (phone vs. video), and clinician type (physician vs. advanced practice clinician) and subsequent healthcare use relative to standard nurse advice line recommendations. The primary outcome was ED (VA and non-VA) use within 7 days of the index nurse advice line call. Secondary outcomes included hospitalization within 7 days, 30-day mortality, and concordance between the clinical recommendation and the Veteran's subsequent action. Three types of calls were included in the evaluation: "emergent 911" (advised to call 911 but declined), "emergent" (evaluation within 2 hours), and "urgent" (evaluation within 2 to 8 hours). Of more than 2.5 million calls during the evaluation period, nearly 100,000 calls resulted in a TEC visit.

FINDINGS:

• Receipt of TEC was associated with fewer ED visits within 7 days compared to nurse triage alone (29% vs. 45%), without increases in hospitalization or mortality. This association was most pronounced among calls triaged as “emergent” (-22%) and “emergent 911” (-19%), and smaller among “urgent” calls (-6%).
• Minimal differences were observed by TEC modality or clinician type.
• Concordance between TEC recommendation and Veteran behavior was moderate and higher than concordance for nurse triage, with similar concordance across TEC modalities and clinician types.
• At the facility level, TEC implementation was not associated with a significant overall reduction in ED visits (a small reduction was observed for emergent calls only) and was not associated with differences in hospitalization or mortality.

IMPLICATIONS:

• Broader implementation of TEC could help ensure Veterans with urgent health concerns receive timely access to emergency expertise while safely reducing ED visits, preserving in-person capacity for those who need it most.

LIMITATIONS:

• Although data were adjusted for a wide range of Veteran and clinical characteristics, residual confounding may have influenced results.
• TEC implementation varied across sites and was staggered over time.

AUTHOR/FUNDING INFORMATION:
This evaluation was co-funded by QUERI (QUERI EBP 22-108). Drs. Tran and Rose are with HSR’s Health Economics Resource Center (HERC). Drs. Ferguson and Vashi and Ms. Urech are with HSR’s Center for Innovation to Implementation (Ci2i).

Li KY, Tran LD, Rose L, Ferguson JM, Urech T, Buggaveeti AE, Vashi AA. Acute Care Use and Mortality by Tele-Emergency Care Use, Modality, and Clinician Type. JAMA Network Open. April 6, 2026;9(4):e265406.