A 5-year-old child, in medical distress at a rural emergency room in northern California, is stabilized enough to avoid having to be rushed 50 miles to a pediatric critical care unit at a regional tertiary hospital. A video intervention in the rural setting saves hours of diagnostic delay, the costs of the trip and a high-intensity hospital stay.

In a quite different setting, a geriatrician talks to the nurse on duty at a skilled nursing facility in Pennsylvania about a sudden change in an elderly resident’s condition, reassuring her remotely that the situation doesn’t call for the once-standard reaction of calling for transport to an ER. The SNF keeps the resident in place, retaining revenue and preserving a comforting routine. The hospital avoids a Medicare penalty for a too-soon readmission.

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