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

NCT07546071 | Completed

• 1 other identifier: SMC-2688-25
• Study Type: interventional
• Target: 200
• Locations: 1 country
• Sites: 1

Brief Summary

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.

Conditions

Emergency Care; Telemedicine; Emergency Department Crowding

Outcome Measures

Primary Outcomes (1)

• 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 Outcomes (3)

• Return Visits to the Emergency Department

  Within one week after the ED visit

• Accuracy of Physician Assessment for ED Referral

  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

  One week after the ED visit

Study Arms (2)

Study Group / Telemedicine Group

EXPERIMENTAL

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

Control Group

NO INTERVENTION

Participants receive standard emergency department care without a prior video consultation.

Interventions

Telemedicine-Based Remote Physician Assessment BEHAVIORAL

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.

Study Group / Telemedicine Group

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

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

You may not qualify if:

• 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

Sponsors & Collaborators

• Sheba Medical Center: lead

Study Sites (1)

Sheba Medical Center

Ramat Gan, Israel

Location

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER GOV
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: MD

Study Record Dates

• First Submitted: April 5, 2026
• First Posted: April 22, 2026
• Study Start: November 19, 2025
• Primary Completion: January 31, 2026
• Study Completion: January 31, 2026
• Last Updated: April 22, 2026

Record last verified: 2026-04

Data Sharing

• IPD Sharing: Will not share

Locations

IL (1)