The acceptability and safety of video triage for ambulance service patients and clinicians during the COVID-19 pandemic

Abstract

Introduction: In response to anticipated challenges with urgent and emergency healthcare delivery during the early part of the COVID-19 pandemic, Yorkshire Ambulance Service NHS Trust introduced video technology to supplement remote triage and ‘hear and treat’ consultations as a pilot project in the EOC. We conducted a service evaluation with the aim of investigating patient and staff acceptability of video triage, and the safety of the decision-making process.Methods: This service evaluation utilised a mixture of routine and bespoke data collection. We sent postal surveys to patients who were recipients of a video triage, and clinicians who were involved in the video triage pilot logged calls they attempted and undertook.Results: Between 27 March and 25 August 2020, clinicians documented 1073 triage calls. A successful video triage call was achieved in 641 (59.7%) cases. Clinical staff reported that video triage improved clinical assessment and decision making compared to telephone alone, and found the technology accessible for patients. Patients who received a video triage call and responded to the survey (40/201, 19.9%) were also satisfied with the technology and with the care they received. Callers receiving video triage that ended with a disposition of ‘hear and treat’ had a lower rate of re-contacting the service within 24 hours compared to callers that received clinical hub telephone triage alone (16/212, 7.5% vs. 2508/14349, 17.5% respectively).Conclusion: In this single NHS Ambulance Trust evaluation, the use of video triage for low-acuity calls appeared to be safe, with low rates of re-contact and high levels of patient and clinician satisfaction compared to standard telephone triage. However, video triage is not always appropriate for or acceptable to patients and technical issues were not uncommon.

Contribution of Live Video to Physicians’ Remote Assessment of Suspected COVID-19 Patients in an Emergency Medical Communication Centre: A Retrospective Study and Web-Based Survey

“…We noted that the failure rate of live video was 22.2%, which was slightly higher than the Danish study (17.8%) [ 17 ] and the English study (16.9%) [ 27 ]. It is possible that this is partly related to the fact that our EMCC only started using the Instantview ® tool on 20 March 2020, so there was only a very short learning phase for physicians.…”

“…As in the Danish study, the causes of failure or difficulties were mainly related to the users’ handling of the smartphones or non-receipt/difficulty in accessing the SMS URL link. As with all published studies on the subject [ 17 , 27 , 28 , 30 ], acceptance of the video was excellent by both callers and physicians and was also considered easy to use.…”

“…The value of using live video, even after an advanced telephone assessment by a second-line physician, thus seems to persist. Another study showed that 22.4% of patients who were initially classified in the least severe category after telephone-only triage were reclassified to the most severe categories after reassessment using live video [ 27 ].…”

Study of prehospital video telehealth for callers with mental health-related complaints

“…In the face of increasing EMS demand, novel strategies to improve ambulance resource availability are needed. One previous study described the use of video consultation in an emergency call-taking centre 11. In that report, video triage technology was implemented for low-acuity ‘hear and treat’ consultations in the UK.…”

The Emergency Performance of the Hungarian Ambulance Service during the COVID-19 Pandemic

“…Because this study was conducted relatively early during the pandemic, the researchers could only investigate the first COVID-19 wave; thus, there is no information regarding the impact of the following more severe waves, which could be useful for those organizing emergency ambulance services. Although other articles have discussed the increased burden on ambulance services during the COVID-19 pandemic, these published papers mainly focused on how to identify COVID-19 infections and other factors related to medical technology [ 17 , 18 , 19 , 20 ]. Owing to the lack of knowledge and the concern that a new global pandemic may emerge in the future, it is important to investigate this question thoroughly.…”