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The unprecedented challenges brought on by COVID-19 transformed telehealth and care at home from fringe novelties to mainstream practices. Just as COVID-19 may become part of a “new normal,” it seems that acute care in the home is likely here to stay. 

This is something we think about every day at instED®, New England’s longest-running end-to-end mobile in-home urgent care service. We believe that a large share of patients can be just as well served—if not better served—through care that comes to them. In fact, a recent study published in the American Journal of Managed Care found CCA members receiving urgent care from paramedics in their home through instED reported more satisfaction than patients receiving care in emergency departments. 

Of course, this service requires special skills, knowledge, and tools. For example, our paramedics bring the full toolkit of Advanced Life Support. This means we can provide many of the services as the emergency department (ED), such as nearly instant lab testing, intravenous medications and fluids, and EKG testing, to name just a few. Our paramedics undergo hundreds of hours of specialized training. With all this at our disposal, there’s so much that we at instED can do to help you and your patients.

With this in mind, it makes sense to consider who really needs the ED, and who might be better served with professional in-home urgent treatment. Here are examples of when an ED visit is appropriate and when to request an instED visit: 

Emergency Department Appropriate:instED Appropriate/ED Avoidable
  • Immediately life-threatening illness or injury: heart attack, stroke, trauma, sepsis
  • Conditions that require surgery
  • Conditions that require advanced diagnostics, such as CT or MRI imaging
  • Conditions that require several hours of treatment or more
  • Patients who greatly prefer care in the hospital
  • Infections without sepsis or shock (e.g., UTI/pyelonephritis, cellulitis, pneumonia, and undifferentiated upper or lower respiratory infections, including COVID-19)
  • Injuries or pains that are unlikely to require imaging (e.g., low risk of fracture or internal hemorrhage)
  • Moderate exacerbations of CHF, COPD, diabetes, and other chronic conditions
  • Dehydration/hypovolemia
  • Suspected electrolyte abnormality
  • Moderate gastroenteritis needing fluids or medication
  • Abdominal pain unlikely to require imaging
  • Situations where patients greatly wish to remain at home and can reasonably understand and communicate

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