Oceans apart, connected together. Insights series

Impact 1: Reducing Avoidable Emergency Department Presentations Through Telehealth-Enabled Early Recognition of Deterioration

Authors:

Zainab Almukhtar

Tara Marshall

Introduction

Emergency department (ED) overcrowding is one of the most significant challenges facing healthcare systems in both the United Kingdom and Canada. Rising demand, increasing numbers of older adults living with frailty and multiple long-term conditions, workforce shortages and limited access to timely community-based care continue to place unprecedented pressure on emergency services (NHS England, 2019; CIHI, 2025).

Evidence increasingly demonstrates that many emergency department attendances are avoidable when deterioration is recognised early and appropriate intervention is initiated within community and long-term care settings. Telehealth, when combined with standardised clinical assessment tools such as the National Early Warning Score (NEWS2), provides clinicians and care staff with the capability to identify physiological deterioration sooner, support timely clinical decision-making and enable people to remain safely in the place they call home.

Within the Leicester, Leicestershire and Rutland (LLR) Connected Care Programme, implementation of telehealth-enabled NEWS2 demonstrated measurable improvements in proactive care delivery.

Evidence from the Connected Care Programme Pilot

Implementation of NEWS2 supported by telehealth across care homes and supported living services resulted in significant improvements in early recognition and clinical escalation.

Key outcomes included:

• More than 23,000 clinical observations completed using telehealth-enabled monitoring.

• 1,464 NEWS2 assessments undertaken to support structured clinical decision-making.

• 87% of participating care homes reported reductions in avoidable hospital admissions.

• 687 hospital admissions avoided across the programme cohort.

• Earlier recognition of physiological deterioration enabled timely intervention, reducing unnecessary emergency department transfers while supporting treatment within care homes wherever clinically appropriate.

• Individual case reviews demonstrated reductions in repeated NHS 111 calls, avoided ambulance conveyance and improved management of residents receiving end-of-life care.

These findings demonstrate that telehealth is most effective when embedded within structured clinical pathways that combine workforce education, standardised assessment and agreed escalation processes.

Relevance for Canada

Canada is experiencing similar pressures.

The Canadian Institute for Health Information (CIHI) reports that approximately 15% of emergency department visits are for conditions that could potentially be managed within primary care, while approximately 9% could potentially be managed through virtual primary care services (CIHI, 2025). These findings suggest considerable opportunity for telehealth to reduce unnecessary emergency department demand through earlier intervention and improved access to community-based care.

Emergency department crowding disproportionately affects:

• older adults living with frailty;

• residents of long-term care homes;

• rural and remote communities;

• individuals living with multiple chronic conditions;

• populations experiencing health inequities.

Canadian evidence further demonstrates that virtual care alone is insufficient to reduce emergency department demand. Rather, telehealth delivers greatest value when integrated into proactive, multidisciplinary models of care that strengthen workforce capability, improve communication between sectors and support timely clinical decision-making (CIHI, 2025).

Evidence from British Columbia demonstrated that introducing virtual physicians into the HealthLink BC 8-1-1 service resulted in approximately 16 fewer emergency department visits per 1,000 patients within 30 days, while increasing access to primary care without increasing overall healthcare costs (McGrail et al., 2025).

Similarly, Ontario's Long-Term Care+ (LTC+) model demonstrated that virtual specialist consultation improved access to urgent clinical expertise, strengthened workforce confidence and supported more residents to remain safely within long-term care settings rather than being transferred unnecessarily to hospital (Costa et al., 2025).

Discussion

The combined evidence from the United Kingdom and Canada demonstrates that telehealth should not be viewed simply as a technology for remote consultation. Instead, it functions as an enabling infrastructure that supports proactive deterioration management, strengthens clinical communication and facilitates coordinated multidisciplinary care.

The greatest reductions in emergency department presentations occur where telehealth is combined with:

• structured physiological assessment (NEWS2);

• workforce education and competency;

• standardised escalation pathways;

• multidisciplinary collaboration;

• continuous quality improvement.

Technology alone does not reduce emergency department attendances. It is the combination of technology, implementation science and behavioural change that enables earlier recognition of deterioration and supports people to receive appropriate care closer to home.

Conclusion

Both Canadian and UK evidence demonstrates that telehealth-enabled deterioration management has significant potential to reduce avoidable emergency department presentations, improve patient outcomes and strengthen system resilience.

As healthcare systems continue to respond to increasing demand and workforce pressures, integrating standardised early warning systems such as NEWS2 with telehealth-enabled proactive care represents an evidence-based opportunity to shift care upstream, reduce avoidable hospital utilisation and enable more people to remain safely in the place they choose to call home.

References

Canadian Institute for Health Information (CIHI). (2025). Primary and Virtual Care Access: Emergency Department Visits for Primary Care Conditions. Ottawa, ON: CIHI. Available at: https://www.cihi.ca/en/primary-and-virtual-care-access-emergency-department-visits-for-primary-care-conditions

Costa, A.P., et al. (2025). Evaluation of the Long-Term Care+ Virtual Care Model in Ontario. Journal of the American Medical Directors Association. Available via ScienceDirect.

Darzi, A. (2008). High Quality Care for All: NHS Next Stage Review Final Report. London: Department of Health.

McGrail, K.M., et al. (2025). Impact of Virtual Physicians within the HealthLink BC 8-1-1 Service on Emergency Department Utilisation. npj Digital Medicine, 8. Available from: https://www.nature.com/articles/s41746-025-02060-9

NHS England. (2019). The NHS Long Term Plan. London: NHS England.

These Hands Academy. (2025). Connected Care Programme Evaluation: Leicester, Leicestershire and Rutland. Internal evaluation report.