TeleFAST: Pooling Remote Physician Capacity Across Emergency Departments to Improve On-Site Flow and System Resilience
Abstract
Abstract Background Emergency department (ED) crowding is driven by low-acuity visits that consume physician capacity and lengthen wait times. In Portugal, nearly 40% of ED visits are low-acuity (Manchester Triage System II [MTS II] blue or green). ED demand fluctuates, but conventional fast-track models (FTMs) depend on on-site physician availability, limiting absorption of demand peaks. TeleFAST is a centralised telemedicine FTM that pools remote physician capacity across multiple EDs. Methods A multicentre observational study was conducted across four EDs (CUF Hospital Network, Portugal; November 2024–January 2026), comprising a retrospective cohort comparison of TeleFAST versus standard of care (SoC) among low-acuity adults meeting fast-track eligibility criteria, and a cross-sectional survey of healthcare professionals (HCPs) delivering TeleFAST. Outcomes included ED length of stay (LOS), resource utilisation, workload variability, and 72-hour and 7-day reattendance. Between-group comparisons used Wilcoxon rank-sum, chi-square, and Fisher's exact tests. Mixed-effects models adjusted for MTS II presenting flowchart assessed operational outcomes, and logistic regression assessed reattendance. A Resilience Index (RI) was developed to assess demand buffering. Survey analyses included construct scoring, Cronbach's alpha, and correlations among technology acceptance, organisational readiness, and usability constructs. Results A total of 7046 ED visits were analysed (TeleFAST…
How strong is the evidence?
Evidence Hub reads this as a cross-sectional, done in people. Its evidence level is 4 of 5 (Low · observational). Observational designs can show an association but not prove cause. Reported size: 3,677 participants or records.
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