Emergency TeleNeurosurgery Physician Consultation Program and Associated Health Care Utilization Benefits

Hospital overcrowding and bed shortages significantly limit access and delivery of care across the United States, particularly in tertiary centers (TCs) managing complex neurosurgical patients. Community hospitals that lack neurosurgical infrastructure frequently transfer patients with low-acuity neurological presentations to TCs, contributing to unnecessary strain on tertiary care resources. Here we sought to evaluate the clinical, operational, and financial impacts of a prospectively implemented teleneurosurgery consultation program designed to reduce unnecessary transfers and optimize overall health care system efficiency.

We retrospectively analyzed 324 teleneurosurgery consults conducted between January 2023 and December 2024 across 3 community hospitals affiliated with our tertiary academic center. Patient demographics, presenting symptoms, consult outcomes, transfer rates, and surgical interventions were recorded. Cost savings from avoided transfers were calculated using Medicare's Ambulance Fee Schedule. Revenue retained at community hospitals and financial benefit to the TC were estimated using national average Diagnosis-Related Group payment data.

Of 324 consults, 272 (83.9%) did not result in transfer to the TC. Common presentations and diagnoses such as ground-level falls (n = 215) and stable intracranial hemorrhages (n = 190) were often managed without transfer. Avoided transfers translated to estimated transport cost savings ranging from $36 299 (ambulance) to $14.8 million (airlift). Community hospitals retained $985 111 in Diagnosis-Related Group-related revenue, while the TC preserved 831 bed-days and gained $1 079 402 by reserving capacity for higher-acuity, higher-reimbursing cases.

The TeleNeurosurgery program significantly reduced unnecessary transfers, conserved critical care resources, and produced substantial financial benefits for both community and TCs. These findings support broader adoption of teleneurosurgical consultation models to address hospital capacity strain and promote more efficient health care delivery.