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 departments is of major concern. Attempts to reduce the costs of emergency cardiac care have thus far focused primarily on medical and administrative management 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 costs. Methods: During a 6-month period, a random group of subscribers who had called for medical assistance during the previous 24 h were asked what action they would have taken had they not been Shahal subscribers. All study patients 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 hospital facilities. A mobile intensive care unit was dispatched in 412 (26%) cases. A cost estimate of abuse indicated that the service resulted in a savings to the national economy of approximately $830,000 per 10,000 members per year. Conclusions: This study demonstrated that Shahal membership can reduce costs of medical care and the number of hospital emergency department visits.