Tele‐Emergency Care Reduced Emergency Department Visits and Shifted Care to Primary Care Settings in the Veterans Affairs System

ABSTRACT Objective To estimate the effect of tele‐emergency care (TEC) on emergency department (ED) use, downstream care, and costs among patients triaged as needing urgent evaluation. Study Setting and Design We studied TEC within the Veterans Health Administration (VHA) using a regression discontinuity design that exploited brief, routine operational pauses in TEC availability. Patients who called a nurse advice line shortly before a pause were substantially more likely to receive TEC than otherwise comparable patients who called shortly after the pause began. Data Sources and Analytic Sample We used VHA records, including VA‐provided and VA‐paid community care encounters, for 35,249 nurse triage calls with an urgent recommendation placed during business hours at VA facilities offering TEC between December 2023 and June 2025. Principal Findings Calling just after a pause began raised the probability of an ED visit within 3 days by 7.5 percentage points (baseline, 45.8%). Scaling by the first stage, TEC reduced ED visits within 3 days by 27.5 percentage points, with the reduction concentrated at VA‐paid community care facilities (−18.4 percentage points). TEC increased primary care visits within 7 days by 9.3 percentage points. Thirty‐day mortality and inpatient admission were unchanged. Total 30‐day health care costs were not significantly different (+$983 per recipient; SE, $822). Conclusions Tele‐emergency care reduced avoidable ED visits and redirected patients toward primary care without detectable effects on mortality or admission. Health systems should consider TEC to redirect avoidable ED visits.