Abstract
Abstract
Background
Emergency departments (EDs) face persistent challenges related to overcrowding, boarding, ambulatory care access barriers, and workforce strain, contributing to compromised patient care and high rates of physician burnout. Virtual care has emerged as a potential strategy to alleviate pressure on emergency care systems. In 2020, the Veterans Health Administration (VA) launched the national Tele-Emergency Care (TEC) program, in which patients who call a call center can be connected to an emergency medicine clinician by phone or video. Although virtual care may help address ED capacity and clinician burnout, the perspectives of emergency medicine–trained clinicians remain limited.
Objective
The aim of this study is to examine the experiences of emergency medicine clinicians participating in VA’s TEC program.
Methods
As part of a national mixed methods evaluation of TEC, we conducted semistructured interviews with clinicians delivering emergency care through TEC between February 2025 and June 2025. Participants (n=15) were recruited via multistage purposeful sampling from 4 of 18 regional TEC programs that varied in geography, volume, duration, and operational models. Interviews explored experiences of providing care in a virtual environment, including perceived benefits and challenges. We performed a descriptive qualitative analysis.
Results
We interviewed 14 physicians and 1 nurse practitioner with formal emergency medicine training. Interviewees described four primary themes: (1) clinical decision-making in a virtual environment; (2) development of the provider-patient relationship; (3) clinician job satisfaction and professional well-being; and (4) challenges. Participants reported that TEC provided perceived opportunities to avoid ED referrals, more focused patient interactions, and improved job satisfaction related to flexible virtual shifts. Reported challenges included filling primary care gaps and performing care coordination tasks.
Conclusions
TEC represents an emerging model of emergency care delivery that clinicians perceive may expand access, prevent avoidable ED visits, and support clinician well-being while also introducing distinct clinical and operational challenges. Our findings can inform the implementation of similar emergency telehealth services in other health systems.