TeleFAST: Pooling Remote Physician Capacity Across Emergency Departments to Improve On-Site Flow and System Resilience

<title>Abstract</title> <p> 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 n = 3677; SoC n = 3369). TeleFAST reduced median LOS by 43 minutes (74 vs 117 minutes; <italic>p</italic>  &lt; 0.001; adjusted − 34.8 minutes) and time to first observation by 9 minutes (p &lt; 0.001). Diagnostic and therapeutic interventions were lower in TeleFAST (all <italic>p</italic>  &lt; 0.001), and 96% were managed remotely. Reattendance at 72 hours and 7 days did not differ ( <italic>p</italic>  &gt; 0.05). Total low-acuity demand variability (SD = 11.7) exceeded SoC workload variability (SD = 6.7; RI = 0.42), indicating buffering. HCPs reported positive attitudes and intention to use (4.29–4.33), acceptable usability (SUS 71.8/100), and moderate organisational readiness (3.52–3.79). Conclusions TeleFAST improved ED efficiency and maintained short-term safety while buffering on-site workload variability. By pooling physicians across EDs, it addresses the structural dependence of conventional FTMs on local staffing. Centralised telemedicine FTMs may represent a scalable, resilient workforce model for low-acuity demand in multi-site emergency care. </p>