Potential reduction of costs and hospital emergency department visits resulting from prehospital transtelephonic triage - the Shahal experience in Israel

Background: The rising cost of services provided by hospital emergency depa rtments is of major concern. Attempts to reduce the costs of emergency card iac care have thus far focused primarily on medical and administrative mana gement in the hospital. The role of the patient in appropriate prehospital decision-making has been generally ignored. Hypothesis: Membership in "Shahal" (an integrative telemedicine system) may have beneficial effects on patient decision-making and national health cos ts. Methods: During a 6-month period, a random group of subscribers who had cal led fur medical assistance during the previous 24 h were asked what action they would have taken had they not been Shahal subscribers. All study patie nts were followed for at least 7 days. Results: In all, 1,608 subscribers (age 71 +/- 13 years) were included. Of these, 514 replied that they "would have waited," 363 "would have contacted their physicians," and 731 "would have sought emergency department care." Of the presenting medical problems, 86% were resolved without utilizing hos pital facilities. A mobile intensive care unit was dispatched in 412 (26%) cases, A cost estimate of abuse indicated that the service resulted in a sa vings to the national economy of approximately $830,000 per 10,000 members per year. Conclusions: This study demonstrated that Shahal membership can reduce cost s of medical care and the number of hospital emergency department visits.