A Comprehensive Review of Telemedicine Roles in Emergency Department Settings

Abstract

Emergency departments (EDs) worldwide face persistent challenges including overcrowding, workforce shortages, prolonged waiting times, and inequitable access to specialist care. Telemedicine has emerged as a promising strategy to complement traditional emergency care by enabling remote triage, pre-hospital assessment, specialist consultation, and follow-up. This comprehensive review synthesises the available evidence on the roles, effectiveness, economic impact, implementation barriers, and regulatory considerations of telemedicine in emergency department settings.

The review examines six major domains: telemedicine in emergency triage and pre-hospital care; remote specialist consultation in acute and high-acuity emergencies; clinical effectiveness, patient outcomes, and quality of care; cost-effectiveness and resource utilisation; implementation barriers, technological challenges, and facilitators; and regulatory, ethical, and future directions for tele-emergency medicine. Evidence was drawn from systematic reviews, randomised controlled trials, observational studies, economic evaluations, qualitative studies, and policy documents, and was synthesised thematically across clinical, economic, organisational, and ethical dimensions.

The findings indicate that tele-triage improves diagnostic accuracy, reduces re-consultation rates, enhances treatment adherence, and shortens emergency department throughput times, although its impact on high-acuity presentations remains less pronounced. Pre-hospital teleconsultation reduces on-scene time, improves stroke and trauma outcomes, and decreases unnecessary interfacility transfers. Remote specialist consultation—particularly telestroke, tele-trauma, tele-ICU, and cardiac teleconsultation—reduces door-in-door-out times, increases rates of time-critical interventions such as thrombolysis and thrombectomy, improves functional outcomes, and lowers transfer rates. Economic evaluations consistently demonstrate favourable cost-effectiveness, with transfer avoidance generating savings ranging from US $73 to US $5,118 per encounter. Patient satisfaction with tele-emergency care is generally high. However, implementation is constrained by connectivity limitations, inadequate infrastructure, poor electronic health record integration, insufficient training, clinician resistance, credentialing delays, reimbursement inconsistencies, and the absence of physical examination capabilities. Ethical and regulatory challenges include informed consent in urgent situations, privacy and data protection, cross-border licensure, equity of access, and governance of artificial intelligence. Future directions point toward integrated hybrid care models, AI-assisted decision support, wearable devices, 5G-enabled networks, interoperable regulatory frameworks, and equity-focused implementation.