Leveraging Telemedicine to Reduce ED Overcrowding: The Quirónsalud Virtual Urgent Care Program

Short Apellaniz, Jorge; Álvaro de la Parra, Juan Antonio; Gomez-Meana, Alvaro; Carabias, Lorena; Cordoba, Raul; Arcos, Javier; Blanco, Ángel; del Olmo Rodriguez, Marta

doi:10.1056/cat.22.0422

Cited by 1 publication

(1 citation statement)

References 16 publications

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“…After the first three waves of the COVID-19 pandemic, normal elective care was resumed, with a tendency towards increased virtual care delivery and reduced in-person visits where possible. 22 To control for time-varying confounding due to these and other external factors, we included a reference group comprising three specialties (allergology, cardiovascular surgery and ophthalmology) which were not included in the algorithm and were subject to the same external factors as the study group specialties. Data for this group were collected during the same period as the study group, and trends in primary and secondary outcomes were analysed using the same method.…”

Section: Methodsmentioning

confidence: 99%

Effect of an algorithm for automatic placing of standardised test order sets on low-value appointments and attendance rates at four Spanish teaching hospitals: an interrupted time series analysis

Álvaro de la Parra,

del Olmo Rodríguez,

Caramés Sánchez

et al. 2024

BMJ Open

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ObjectiveReducing backlogs for elective care is a priority for healthcare systems. We conducted an interrupted time series analysis demonstrating the effect of an algorithm for placing automatic test order sets prior to first specialist appointment on avoidable follow-up appointments and attendance rates.DesignInterrupted time series analysis.Setting4 academic hospitals from Madrid, Spain.ParticipantsPatients referred from primary care attending 10 033 470 outpatient appointments from 16 clinical specialties during a 6-year period (1 January 2018 to 30 June 2023).InterventionAn algorithm using natural language processing was launched in May 2021. Test order sets developed for 257 presenting complaints from 16 clinical specialties were placed automatically before first specialist appointments to increase rates of diagnosis and initiation of treatment with discharge back to primary care.Primary and secondary outcome measuresPrimary outcomes included rate of diagnosis and discharge to primary care and follow-up to first appointment index. The secondary outcome was trend in ‘did not attend’ rates.ResultsSince May 2021, a total of 1 175 814 automatic test orders have been placed. Significant changes in trend of diagnosis and discharge to primary care at first appointment (p=0.005, 95% CI 0.5 to 2.9) and ‘did not attend’ rates (p=0.006, 95% CI −0.1 to −0.8) and an estimated attributable reduction of 11 306 avoidable follow-up appointments per month were observed.ConclusionAn algorithm for placing automatic standardised test order sets can reduce low-value follow-up appointments by allowing specialists to confirm diagnoses and initiate treatment at first appointment, also leading to early discharge to primary care and a reduction in ‘did not attend’ rates. This initiative points to an improved process for outpatient diagnosis and treatment, delivering healthcare more effectively and efficiently.

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Section: Methodsmentioning

confidence: 99%