Telehealth in emergency medicine: A consensus conference to map the intersection of telehealth and emergency medicine

Abstract

Introduction: Telehealth has the potential to significantly change the specialty of emergency medicine (EM) and has rapidly expanded in EM during the COVID pandemic; however, it is unclear how EM should intersect with telehealth. The field lacks a unified research agenda with priorities for scientific questions on telehealth in EM. Methods: Through the 2020 Society for Academic Emergency Medicine's annual consensus conference, experts in EM and telehealth created a research agenda for the topic. The multiyear process used a modified Delphi technique to develop research questions related to telehealth in EM. Research questions were excluded from the final research agenda if they did not meet a threshold of at least 80% of votes indicating "important" or "very important." Results: Round 1 of voting included 94 research questions, expanded to 103 questions in round 2 and refined to 36 questions for the final vote. Consensus occurred with a final set of 24 important research questions spanning five breakout group topics. Each breakout group domain was represented in the final set of questions. Examples of the questions include: "Among underserved populations, what are mechanisms by | 1453 HAYDEN Et Al.

“No One Manages It; We Just Sign Them Up and Do It”: A Whole System Analysis of Access to Healthcare in One Remote Australian Community

“…They are also not appropriate for sporadically needed services, particularly emergency medicine. This has led to the growing utilisation of telehealth services to meet these needs [ 34 ].…”

Telemedicine in Emergency Medicine in the COVID-19 Pandemic—Experiences and Prospects—A Narrative Review

“…Numerous studies in emergency medicine and telehealth have investigated the use of telemedicine in prehospital/pre-ED settings [7][8][9][10]. A significant increase in the number of patients admitted with SARS-CoV-2 infections was found during the early stage of the COVID-19 pandemic, which indicates difficulty in obtaining medical help at the beginning of the pandemic, before the implementation of pre-hospital teleconsultations [9].…”

“…Conclusions regarding the use of telehealth in EDs and ICUs are as follows: ED patients and staff were able to decrease exposure to the virus, save PPE and improve communication between patients and healthcare providers, as well as patients and their families [7,18,35].…”

“…Remote patients' evaluation [11,12,[21][22][23][24] Misdiagnosis or delay in diagnosis because of lack of a physical examination [55,56] Reduction of the exposure to COVID-19 by limiting personal contact [7,20,32,33] Lack of learning of clinical, practical, and hands-on medical skills by medical staff and students [49] Triage acceleration [6,11,12] Lack of health care providers' preparation and professional scepticism [58,60] Reduction of the overcrowding in EDs [10] Lack of patient readiness and low patient satisfaction [58] Saving personal protective equipment [18,20] No access to digital tools [54] Telemedical support of medical caregivers and decision-making processes [16,17,30,31,50] Problems with protecting the privacy and confidentiality of patient data [61] Fast communication with foreign-speaking patients [21,22] Lack of telehealth in the curricula study programs [62] Closer and permanent patient monitoring in ICUs and at home. [25,26,28,29,36,37] Regulatory, legal, and administrative barriers [58,60,63] Better coordination of emergency systems…”

The effect of telemental versus in‐person mental health consults in the emergency department on 30‐day utilization and processes of care

“…10 These studies have shown that TMH increases access to mental health providers, 11 increases the proportion of patients with mental health complaints who are discharged home, 12,13 and decreases transfer to psychiatric facilities. 13 However, the effect of TMH on postevaluation utilization 14 and, more specifically, TMH's processes of care are not well established, especially within the VHA. Because TMH providers evaluate and examine patients virtually, they may miss subtler signs and symptoms of life-threatening psychiatric conditions such as delirium, leading to misdiagnosis.…”