Traditional nurse triage vs physician telepresence in a pediatric ED

Marconi, Greg P.; Pham, Phung K.; Grajower, Daniel N.; Nager, Alan L.

doi:10.1016/j.ajem.2013.12.032

Cited by 20 publications

(24 citation statements)

References 31 publications

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“…The primary reason for low scores was ambiguity or low quality relating to the instrument used for assessing attitudes/experiences among participants (i.e., the tool used, its development, validity or reliability, appropriateness within the specific setting), in addition to unclear reporting of response rates or whether the samples surveyed were representative. Three trials ( 16 – 18 ) were of high quality. However, the study by Cady et al ( 16 ) only assessed the outcomes of interest for this review as open-ended feedback post-intervention.…”

Section: Resultsmentioning

confidence: 99%

Barriers and Facilitators for Implementing Paediatric Telemedicine: Rapid Review of User Perspectives

Tully¹,

Case

Arthurs

et al. 2021

Front. Pediatr.

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Background: COVID-19 has brought to the fore an urgent need for secure information and communication technology (ICT) supported healthcare delivery, as the pertinence of infection control and social distancing continues. Telemedicine for paediatric care warrants special consideration around logistics, consent and assent, child welfare and communication that may differ to adult services. There is no systematic evidence synthesis available that outlines the implementation issues for incorporating telemedicine to paediatric services generally, or how users perceive these issues.Methods: We conducted a rapid mixed-methods evidence synthesis to identify barriers, facilitators, and documented stakeholder experiences of implementing paediatric telemedicine, to inform the pandemic response. A systematic search was undertaken by a research librarian in MEDLINE for relevant studies. All identified records were blind double-screened by two reviewers. Implementation-related data were extracted, and studies quality appraised using the Mixed-Methods Appraisal Tool. Qualitative findings were analysed thematically and then mapped to the Consolidated Framework for Implementation Research. Quantitative findings about barriers and facilitators for implementation were narratively synthesised.Results: We identified 27 eligible studies (19 quantitative; 5 mixed-methods, 3 qualitative). Important challenges highlighted from the perspective of the healthcare providers included issues with ICT proficiency, lack of confidence in the quality/reliability of the technology, connectivity issues, concerns around legal issues, increased administrative burden and/or fear of inability to conduct thorough examinations with reliance on subjective descriptions. Facilitators included clear dissemination of the aims of ICT services, involvement of staff throughout planning and implementation, sufficient training, and cultivation of telemedicine champions. Families often expressed preference for in-person visits but those who had tried tele-consultations, lived far from clinics, or perceived increased convenience with technology considered telemedicine more favourably. Concerns from parents included the responsibility of describing their child's condition in the absence of an in-person examination.Discussion: Healthcare providers and families who have experienced tele-consultations generally report high satisfaction and usability for such services. The use of ICT to facilitate paediatric healthcare consultations is feasible for certain clinical encounters and can work well with appropriate planning and quality facilities in place.

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Section: Resultsmentioning

confidence: 99%

Barriers and Facilitators for Implementing Paediatric Telemedicine: Rapid Review of User Perspectives

Tully¹,

Case

Arthurs

et al. 2021

Front. Pediatr.

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“…11 To date, telehealth programs have been associated with successful management of acute infection, rapid pediatric triage in the emergency department, and the provision of timely highquality care in disciplines such as mental health, primary care/internal medicine, cardiology, and dermatology. [25][26][27][28][29][30][31] Additionally, retail clinic care for common conditions is associated with comparable 32 or superior quality and outcomes 17 compared to ambulatory care facilities or emergency departments.…”

Section: Discussionmentioning

confidence: 99%

Patients’ Satisfaction with and Preference for Telehealth Visits

et al. 2015

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BACKGROUND: One-quarter of U.S. patients do not have a primary care provider or do not have complete access to one. Work and personal responsibilities also compete with finding convenient, accessible care. Telehealth services facilitate patients' access to care, but whether patients are satisfied with telehealth is unclear. OBJECTIVE: We assessed patients' satisfaction with and preference for telehealth visits in a telehealth program at CVS MinuteClinics. DESIGN: Cross-sectional patient satisfaction survey. PARTICIPANTS: Patients were aged ≥18 years, presented at a MinuteClinic offering telehealth in January-September 2014, had symptoms suitable for telehealth consultation, and agreed to a telehealth visit when the on-site practitioner was busy. MAIN MEASURES: Patients reported their age, gender, and whether they had health insurance and/or a primary care provider. Patients rated their satisfaction with seeing diagnostic images, hearing and seeing the remote practitioner, the assisting on-site nurse's capability, quality of care, convenience, and overall understanding. Patients ranked telehealth visits compared to traditional ones: better (defined as preferring telehealth), just as good (defined as liking telehealth), or worse. Predictors of preferring or liking telehealth were assessed via multivariate logistic regression. KEY RESULTS: In total, 1734 (54 %) of 3303 patients completed the survey: 70 % were women, and 41 % had no usual place of care. Between 94 and 99 % reported being Bvery satisfied^with all telehealth attributes. Onethird preferred a telehealth visit to a traditional in-person visit. An additional 57 % liked telehealth. Lack of medical insurance increased the odds of preferring telehealth (OR=0.83, 95 % CI,

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“…One was a paediatric ED which found physician telepresence to be equivalent or superior to nurse triage in several categories of evaluation. 19 A limited pilot by Traub et al included 36 patients and supported the safety and patient acceptance of physician telepresence in an ED triage area. 20 The results from this pilot study demonstrate the safety of emergency physician telepresence in the ED along with very favourable ratings by patients and providers which is in line with prior reports.…”

Section: Discussionmentioning

confidence: 99%

“…One was a paediatric ED which found physician telepresence to be equivalent or superior to nurse triage in several categories of evaluation. 19 A limited pilot by Traub et al. included 36 patients and supported the safety and patient acceptance of physician telepresence in an ED triage area.…”

Section: Discussionmentioning

confidence: 99%

EDTITRATE (Emergency Department Telemedicine Initiative to Rapidly Accommodate in Times of Emergency)

2016

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Objective Emergency Department (ED) patient volumes are unpredictable, which can result in service delays and patients leaving without care. We initiated a programme of emergency physician (EP) telepresence in the ED with the objectives of assessing feasibility, safety, patient and provider acceptance, and throughput time. Methods This was a prospective convenience study. Patients presenting to the ED during operation of the study who were planned for placement in the waiting room were considered for enrolment. A faculty EP conducted patient evaluations via telepresence with confirmatory evaluation by the onsite faculty EP prior to disposition. Patient care was either taken to completion by the telemedicine EP or initiated and handed off to the onsite team. Measures included patient demographics, triage class (ESI 1-5), throughput time and a single question satisfaction survey (rating 1-5, 5 most favourable) completed by patients, registered nurses and EPs. Patients were called within 3 days and the electronic health record reviewed at 7 days looking for unscheduled visits and adverse events. Results In total, 130 patients were enrolled. Mean triage class was 3.9 with a median throughput of 150 minutes (IQR = 116.5, 206). Non-telemedicine patients during the same time period with similar triage classes had a median throughput of 287 minutes (IQR = 199, 408). Mean satisfaction scores were: patient 4.91, nurse 4.75, onsite EP 4.47 and telemedicine EP 4.79. There was one potential misdiagnosis and no adverse events. Conclusion Patient evaluation by EP via telepresence is feasible, safe, readily accepted by patients and providers and associated with reduced throughput time.

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Traditional nurse triage vs physician telepresence in a pediatric ED

Cited by 20 publications

References 31 publications

Barriers and Facilitators for Implementing Paediatric Telemedicine: Rapid Review of User Perspectives

Barriers and Facilitators for Implementing Paediatric Telemedicine: Rapid Review of User Perspectives

Patients’ Satisfaction with and Preference for Telehealth Visits

EDTITRATE (Emergency Department Telemedicine Initiative to Rapidly Accommodate in Times of Emergency)

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