Background and objectives: Ambulatory (outpatient) health care organizations continue to respond to the COVID-19 global pandemic using an array of initiatives to provide a continuity of care for both COVID-19 and non-COVID-19 patients. The purpose of this study is to systematically identify the facilitators and barriers experienced by outpatient health care organizations in an effort to maintain effective and efficient patient throughput during the pandemic. Materials and methods: This study systematically reviewed articles focused on initiatives taken by ambulatory care organizations to maintain optimal outpatient throughput levels while balancing pandemic precautions, published during 2020. Results: Among the 30 articles that met the inclusion criteria, three initiatives healthcare organizations have taken to maintain throughput were identified: the use (and enhanced use) of telehealth, protocol development, and health care provider training. The research team also identified three barriers to patient throughput: lack of telehealth, lack of resources, and overall lack of knowledge. Conclusions: To maintain patient throughput during the COVID-19 pandemic, healthcare organizations need to develop strategies such as the use of virtual consultation and follow-up, new guidelines to move patients along the care delivery value-chain, and ongoing training of providers. Additionally, the availability of required technology for telehealth, availability of resources, and adequate knowledge are vital for continuous patient throughput to ensure continuity of care during a pandemic.
La pandemia COVID ha hecho de las consultas telemáticas una herramienta básica en la práctica diaria. El objetivo principal del estudio es valorar los resultados de la aplicación de consultas telemáticas para limitar la movilidad de los pacientes. Son objetivos operativos; proponer un plan de consultas, conocer como limita la asistencia a las consultas, definir qué patologías se benefician mas con este plan. Material y Métodos: Se propone un esquema con la creación de consultas previas a las agendadas para valorar idoneidad y posibilidad de realizarla en acto único no presencial. Resultados: Se han realizado 5619 consultas con una falta de respuesta telefónica del 19%. El 74% de los pacientes fueron resueltos de forma virtual. Existe diferencia entre unidades, siendo mas probable la respuesta telefónica para las consulta de unidad, OR=0.60 o de traumatología general, OR=0.67 y menos para los derivados desde urgencias. El 20% de las consultas no se acompañaban de pruebas complementarias. Las consultas de traumatología general, OR=0.34, control postoperatorio, OR=0.49, y unidades, OR=0.40, cumplieron mejor este requisito. De los pacientes restantes, las consultas de traumatología general, OR=0.50, y las derivadas a unidades, OR=0.54, fueron las que se mas se resolvieron sin acudir presencialmente. Conclusiones: Se han resuelto de forma no presencial el 74% de los pacientes que atendieron a la llamada telefónica. El 20% de los pacientes acuden a la visita sin pruebas complementarias. Las consultas de seguimiento de osteosíntesis y postoperatorio de cirugía artroscópica son las que mas precisan de ser realizadas de forma presencial.
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