Use of a Telehealth Emergency Medicine Service to Reduce Emergency Department Visits Among Patients With Chest Pain

Telehealth emergency medicine services may guide outpatient testing and reduce emergency department (ED) visits for patients with chest pain. We evaluated the utilization and outcomes a telehealth emergency medicine service for chest pain patients referred primarily through a large, integrated health system urgent care network.

We performed a retrospective review of patients with a chief complaint of chest pain for whom Intermountain Health telehealth emergency medicine (TeleEM) was consulted between May 2023 and September 2025. We reviewed patient disposition, including discharge without further testing, referral directly to the ED, or assumption of care by the telehealth emergency medicine service with video consultation, documentation, and outpatient testing. We assessed patient outcomes within 48 hours of TeleEM consultation.

During the 28-month study period, 305 patients with chest pain were referred to TeleEM,; 95.7% of referrals were from urgent cares. In 70.2% of cases (214/305) TeleEM assumed full care of the patient with patient-provider video consultation and clinical documentation. Average patient age was 45.1 years (range: 11-93), 52.8% were female, 71.5% identified as White non-Hispanic, and 87.9% were primarily English-speaking. Of the 214 patients, 37 patients (17.3%) were referred to the ED from the TeleEM service based on telehealth assessment and outpatient testing, while 177 (82.7%) completed TeleEM evaluation and testing without ED referral. Seven of those patients who completed TeleEM care without ED referral (4%) had an ED visit within 48 hours, resulting in 170 patients (79.4%) who underwent TeleEM evaluation and testing for chest pain without an associated ED visit.

Use of a telehealth emergency medicine service allowed a substantial proportion of patients with chest pain to undergo evaluation and outpatient testing by board-certified emergency physicians without requiring an ED visit. This population represents a group traditionally considered high risk and typically referred directly to the ED from urgent care or referral lines. Among patients for whom telehealth emergency medicine assumed care, the majority avoided ED evaluation, suggesting that telehealth emergency medicine services may safely reduce ED utilization for selected patients with chest pain.