Can Higher Community Telehealth Use Reduce ED Congestion, Inpatient/ICU Boarding, and Outcomes?

Introduction: Emergency department (ED) overcrowding remains a pervasive issue across the U.S., contributing to delays in care, prolonged boarding times, and worse clinical outcomes. Telehealth has emerged as a potential strategy to reduce ED strain, but evidence at the population level remains limited. This study investigates whether higher telehealth utilization at each state level is associated with three primary outcomes, i.e, reduced ED congestion, inpatient boarding time, and improved health outcomes, particularly age-adjusted mortality rates.


Methods: This cross-sectional ecological study included data from all 50 U.S. states and Washington, D.C., for the year 2022. Telehealth utilization rates (% of outpatient visits via telehealth) were obtained from the Kaiser Family Foundation. ED visit rates and boarding times were sourced from the CDC and the Agency for Healthcare Research and Quality (AHRQ). Finally, mortality data came from the CDC WONDER data (links are available in the references of actual manuscript). Pearson correlation coefficients were used to assess associations between telehealth use and the three outcome measures.


Results: Across all states, average telehealth utilization was 14.7% (range: 5.8%–27.3%). ED visit rates ranged from 265 to 719 per 1,000 population, while boarding times varied from 98 to 265 minutes. Age-adjusted mortality ranged from 614 to 1,036 per 100,000 residents. A significant inverse correlation between telehealth utilization and ED visit rates (r = -0.43, p = 0.001). Also, a significant inverse correlation with ED boarding times (r = -0.37, p = 0.006) and a moderate inverse correlation with age-adjusted mortality (r = -0.31, p = 0.02). However, given the study’s cross-sectional design, causality cannot be inferred. Limitations include the exclusion of confounders such as broadband access and healthcare infrastructure variability.


Conclusions: Higher telehealth utilization was significantly associated with lower ED visit volumes, shorter boarding times, and reduced age-adjusted mortality. These findings suggest that a robust telehealth infrastructure may improve outcomes. Future studies should explore longitudinal and interventional designs to confirm associations and guide policies. Investment in equitable telehealth expansion, particularly in underserved areas.