Ochsner Health’s emergency department teams were experiencing frustration and burnout. Trained to take care of people with high acuity conditions, emergency physicians often had to address patients with lower acuity illness in order to get to the patients who needed their expert medical training.
Doctors asked for workflow improvements, recalled Philip Oravetz, MD, MPH, MBA, a family physician and Ochsner Health’s chief population health officer.
Ochsner Health is part of the AMA Health System Member Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine. Serving Louisiana and the Gulf South, Ochsner Health comprises 46 owned, managed and affiliated hospitals, 370 health and urgent care centers, and 40,000 team members.
The Louisiana-based health system decided it was time for a change. The solution: a virtual emergency department service (OvED) that offers centralized virtual care with a board-certified emergency medicine physician. A dedicated emergency department navigator contributes the “secret sauce” to this service, ensuring that patients get the care directed by the physician, Dr. Oravetz said during a presentation at the AMA’s inaugural Insight Network Summit in Chicago.
OvED is relatively new, having launched in the fall of 2024. It initially targeted an older adult risk population of 130,000 patients, contributing to decreasing emergency department use by more than 7%. While it’s not systemwide yet, the initiative has already significantly reduced Level 5 triage visits, which is when a patient’s condition is nonemergent but needs treatment.
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Quick turnaround to create virtual ED
Emergency department visits are expensive and often involve longer wait times. They are overly used because many patients don’t need emergency room care for lower acuity conditions. This causes critical resources to often be diverted from higher acuity cases.
As a result, emergency physicians are constantly juggling resources and managing lower acuity cases while delivering emergency care to patients who need it, said Dr. Oravetz.
Ochsner Health had about 10 years of experience using remote-patient monitoring, with more than 40,000 patients enrolled in remote monitoring for conditions such as hypertension and diabetes. Nearly 10% of all visits in its system were virtual.
“Why not have a virtual ED?” said Dr. Oravetz.
The goal was to establish a three-pronged approach to reduce avoidable ED visits, encompassing access to care, physician and patient navigator education and management of high utilizers.
This was agile innovation, meaning the idea started with the ED physicians in August of 2024 and went live on October 1st. The process started with stakeholder buy-in, appointing operational leaders, followed by Epic and operations workflows, and mapping and testing of the service, as well as training. The key leaders include Lisa Fort, MD, an emergency physician and clinical informaticist and ACMIO for the Ochsner system. She was joined by Noah Pores, MD, who was appointed as the medical director of the program, Jon Michael Cuba, MD, as system chair of Emergency Medicine, Lauren Defrates VP-EM service line, Jeffrey Kuo, MD, system chair of Patient Flow Center, and Tressy Gleason as ED navigation case management leader.
Since its launch, OvED continues to optimize, which includes ongoing training of its physicians and navigators and optimization of the platform.
Navigator streamlines care
The OvED system runs from 8 a.m. to 8 p.m. seven days a week, assigning a dedicated emergency physician and partnered care navigator. On average, OvED sees about 44 patients per day.
Patients can talk with an emergency physician who might say, “You know what? You probably should get in to see a headache neurologist, so you don't keep coming back,” said Dr. Oravetz. The navigator then schedules that appointment for the patient.
If a patient does end up needing the emergency department, the ED physician will tee up all the orders, ensuring that the workup can be initiated at the time the patient reaches the ED. This not only improves throughput, but it also improves patient experience and outcomes, he said. The ED physicians are also able to refer patients to the best ED by consulting the OEDOCS (Ochsner ED Overcrowding Score) dashboard and reviewing services available, reducing wait times and avoiding unnecessary transfers.
Most patients no longer need the ED
To date, there’s been a 7% decrease in emergency department use among older adults. Also, fewer patients come to the emergency department with a Level 4 or 5 triage visit anymore. Nurses on the 24-hour triage line, as well as Ochsner Health’s primary care doctors, are learning that they can send patients to the virtual ED. The program also takes referrals from primary care, specialty clinics and urgent care.
“Our nurse triage line is the largest referral source for OvED,” Dr. Oravetz said.
About 70% of patients overall are now avoiding the emergency department, which is incredible, he said. Patients are enthusiastic about the program and often can receive care via digital or telehealth platforms, reducing cost and promoting convenient often in-home options.
The program has been making its mark around Greater New Orleans, on Louisiana’s South and North shores, and in Baton Rouge.
“We'll be statewide here soon with the region closely following,” said Dr. Oravetz. To date, 12,000 patients have gone through the OvED system.
