Electronic personal protective equipment: A strategy to protect emergency department providers in the age of COVID-19

Turer, Robert W; Jones, Ian D.; Rosenbloom, S. Trent; Slovis, Corey M.; Ward, Michael J.

doi:10.1093/jamia/ocaa048

Cited by 101 publications

(95 citation statements)

References 15 publications

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“…Telemedicine has been recognized as an efficient tool for providing electronic personal protective equipment (ePPE) to health-care workers [32]. It might help to protect staff and save PPE while providing rapid access to emergency care in orthopaedics.…”

Section: Electronic Personal Protective Equipmenttelemedicine (Epep)mentioning

confidence: 99%

COVID-19 coronavirus: recommended personal protective equipment for the orthopaedic and trauma surgeon

Hirschmann

Hart

Henckel

et al. 2020

Knee Surg Sports Traumatol Arthrosc

190

218

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Purpose With the COVID-19 crisis, recommendations for personal protective equipment (PPE) are necessary for protection in orthopaedics and traumatology. The primary purpose of this study is to review and present current evidence and recommendations for personal protective equipment and safety recommendations for orthopaedic surgeons and trauma surgeons. UK) for consideration in the presented practice recommendations. Results World Health Organization guidance for respiratory aerosol-generating procedures (AGPs) such as intubation in a COVID19 environment was clear and included the use of an FFP3 (filtering face piece level 3) mask and face protection. However, the recommendation for surgical AGPs, such as the use of high-speed power tools in the operating theatre, was not clear until the UK Public Health England (PHE) guidance of 27 March 2020. This guidance included FFP3 masks and face protection, which UK surgeons quickly adopted. The recommended PPE for orthopaedic surgeons, working in a COVID19 environment, should consist of level 4 surgical gowns, face shields or goggles, double gloves, FFP2-3 or N95-99 respirator masks. An alternative to the mask, face shield and goggles is a powered air-purifying respirator, particularly if the surgeons fail the mask fit test or are required to undertake a long procedure. However, there is a high cost and limited availabilty of these devices at present. Currently available surgical helmets and toga systems may not be the solution due to a permeable top for air intake. During the current COVID-19 crisis, it appeared that telemedicine can be considered as an electronic personal protective equipment by reducing the number of physical contacts and risk contamination. Conclusion Orthopaedic and trauma surgery using power tools, pulsatile lavage and electrocautery are surgical aerosolgenerating procedures and all body fluids contain virus particles. Raising awareness of these issues will help avoid occupational transmission of COVID-19 to the surgical team by aerosolization of blood or other body fluids and hence adequate PPE should be available and used during orthopaedic surgery. In addition, efforts have to be made to improve the current evidence in this regard. Level of evidence IV.

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Section: Electronic Personal Protective Equipmenttelemedicine (Epep)mentioning

confidence: 99%

COVID-19 coronavirus: recommended personal protective equipment for the orthopaedic and trauma surgeon

Hirschmann

Hart

Henckel

et al. 2020

Knee Surg Sports Traumatol Arthrosc

190

218

View full text Add to dashboard Cite

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“…2 This allowed a safe, comfortable, and humane one-on-one interaction for both parties and created our very own electronic PPE as per Turer et al's definition. 1 In our case, adapting this system came at little to no cost since the software was free to access and use. This raises the question as to whether such platforms comply with ethics and local general data protection regulation.…”

mentioning

confidence: 89%

“…As COVID-19 continues to challenge healthcare systems worldwide, we read with great interest Turer et al's approach on telemedicine for COVID-19 in the US and we would like to share our center's experience to complement the view from a middle-income country's perspective. 1 Since a complete telemedicine program can't be created overnight, we faced the fact that it hasn't been a priority at our public hospitals to strengthen telemedical innovations. As such, we had to develop health informatics tools for the use of patients potentially infected with SARS-CoV-2 as the pandemic developed.…”

mentioning

confidence: 99%

“…Patients are summoned, one at a time, to a room with a Skype connection (as Turer et al have previously suggested). 1 There a doctor from the ID team runs a telemedicine consult where the patient can see the physician's face and discuss details about their chief complaint. The physician has the opportunity to ask any further information needed and, if necessary, explain the swabbing procedure to the patient ( Figure 1B).…”

mentioning

confidence: 99%

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Use of self-administered surveys through QR code and same center telemedicine in a walk-in clinic in the era of COVID-19

Pérez-Alba

Nuzzolo-Shihadeh

Espinosa-Mora

et al. 2020

Journal of the American Medical Informatics Association

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“…[10] Telehealth is well-suited for use during pandemics as clinicians can provide care and consultation to isolated populations and counter the surge in demand for medical care while using telehealth as a form of electronic personal protective equipment. [9,11,12,13] Telehealth in the COVID-19 era is, thus, theorized as a useful strategy in "forward triage," the sorting of patients prior to their arrival in the emergency department [13,14] and as a means to provide patient guidance and reassurance [11].…”

Section: Introductionmentioning

confidence: 99%

On the Front (Phone) Lines: Results of a COVID-19 Hotline in Northeast Ohio

Margolius

Hennekes

Yao

et al. 2020

Preprint

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medRxiv preprint Key PointsQuestion: What is the feasibility and effectiveness of physician telehealth services during a pandemic?Findings: In this cohort study of a COVID-19 telehealth hotline that included 10,112 callers and 4,213 physician telehealth visits, most patients (79%) were advised to self-isolate at home, 14% were found unlikely to have COVID-19, 4% dispositions (e.g. testing or office visit) and 3% were advised to immediately seek care emergency department. 83% of patients who were advised to stay home did not require in-person visits.Meaning: Physician-directed telehealth services conserve scarce resources and provide effective, equitable care during a pandemic without compromising patient safety.ABSTRACT Importance: Severe acute respiratory syndrome coronavirus (SARS-CoV-2) and the associated coronavirus disease of 2019 (COVID-19) have presented immense challenges for health care systems. Many regions have struggled to adapt to disruptions to health care practice and employ systems that effectively manage the demand for services.Objective: To examine the effectiveness of the first five weeks' of a 24/7 physician-staffed COVID-19 hotline.Design: Cohort study using electronic health records.Setting: A single large health care system in Northeast Ohio.Participants: During 5 weeks of operation, 10,112 patients called the hotline (callers) and were evaluated by a registered nurse (RN) using standardized protocols. Of these, 4,213 (42%) were referred for a physician telehealth visit (telehealth patients). The mean age of callers was 42 years. 67% were female, 51% white, and 46% were on Medicaid or uninsured.Intervention: Physician telehealth visits for COVID-19. Main Outcomes and Measures:We describe clinical diagnosis, patient characteristics (age, sex race/ethnicity, smoking status, insurance status), and visit disposition. We use logistic regression to evaluate associations between patient characteristics, visit disposition and subsequent emergency department use, hospitalization, and SARS-Cov-2 PCR testing. Results:Common caller concerns included cough, fever, and shortness of breath. Most telehealth patients (79%) were advised to self-isolate at home, 14% were determined to be unlikely to have COVID-19, 3% were advised to seek emergency care, and 4% had miscellaneous other dispositions. A total of 287 (7%) patients had a subsequent ED visit, and 44 (1%) were hospitalized with a COVID-19 diagnosis. Of the callers, 482 (5%) had a COVID-19 test reported with 69 (14%) testing positive. Among patients advised to stay at home, 83% had no further face-to-face visits. In multivariable results, only a physician recommendation to seek emergency care was associated with emergency room use (OR=4.73, 95%CI 1.37-16.39, p=.014). Only older age was associated with having a positive test result. Conclusions and Relevance:Robust, physician-directed telehealth services can meet a wide range of needs during the acute phase of a pandemic, conserving scarce resources such as personal protective equipment and testing sup...

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Electronic personal protective equipment: A strategy to protect emergency department providers in the age of COVID-19

Cited by 101 publications

References 15 publications

COVID-19 coronavirus: recommended personal protective equipment for the orthopaedic and trauma surgeon

COVID-19 coronavirus: recommended personal protective equipment for the orthopaedic and trauma surgeon

Use of self-administered surveys through QR code and same center telemedicine in a walk-in clinic in the era of COVID-19

On the Front (Phone) Lines: Results of a COVID-19 Hotline in Northeast Ohio

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