Use of Telemedicine to Screen Patients in the Emergency Department: Matched Cohort Study Evaluating Efficiency and Patient Safety of Telemedicine

Abstract

Background Early efforts to incorporate telemedicine into Emergency Medicine focused on connecting remote treatment clinics to larger emergency departments (EDs) and providing remote consultation services to EDs with limited resources. Owing to continued ED overcrowding, some EDs have used telemedicine to increase the number of providers during surges of patient visits and offer scheduled “home” face-to-face, on-screen encounters. In this study, we used remote on-screen telemedicine providers in the “screening-in-triage” role. Objective This study aimed to compare the efficiency and patient safety of in-person screening and telescreening. Methods This cohort study, matched for days and proximate hours, compared the performance of real-time remote telescreening and in-person screening at a single urban academic ED over 22 weeks in the spring and summer of 2016. The study involved 337 standard screening hours and 315 telescreening hours. The primary outcome measure was patients screened per hour. Additional outcomes were rates of patients who left without being seen, rates of analgesia ordered by the screener, and proportion of patients with chest pain receiving or prescribed a standard set of tests and medications. Results In-person screeners evaluated 1933 patients over 337 hours (5.7 patients per hour), whereas telescreeners evaluated 1497 patients over 315 hours (4.9 patients per hour; difference=0.8; 95% CI 0.5-1.2). Split analysis revealed that for the final 3 weeks of the evaluation, the patient-per-hour rate differential was neither clinically relevant nor statistically discernable (difference=0.2; 95% CI –0.7 to 1.2). There were fewer patients who left without being seen during in-person screening than during telescreening (2.6% vs 3.8%; difference=–1.2; 95% CI –2.4 to 0.0). However, compared to prior year-, date-, and time-matched data on weekdays from 1 am to 3 am, a period previously void of provider screening, telescreening decreased the rate of patients LWBS from 25.1% to 4.5% (difference=20.7%; 95% CI 10.1-31.2). Analgesia was ordered more frequently by telescreeners than by in-person screeners (51.2% vs 31.6%; difference=19.6%; 95% CI 12.1-27.1). There was no difference in standard care received by patients with chest pain between telescreening and in-person screening (29.4% vs 22.4%; difference=7.0%; 95% CI –3.4 to 17.4). Conclusions Although the efficiency of telescreening, as measured by the rate of patients seen per hour, was lower early in the study period, telescreening achieved the same level of efficiency as in-person screening by the end of the pilot study. Adding telescreening during 1-3 am on weekdays dramatically decreased the number of patients who left without being seen compared to historic data. Telescreening was an effective and safe way for this ED to expand the hours in which patients were screened by a health care provider in triage.

Telehealth Solutions for In-hospital Communication with Patients Under Isolation During COVID-19

“…Typically, telemedicine platforms are used for consultations 14 – 16 or remote treatment monitoring. 17 – 20 Few studies have focused on implementing real-time videoconferencing in the emergency department or inpatient settings, 16 , 21 and none have described a specific implementation strategy for doing so within the unique constraints of the COVID-19 pandemic.…”

Telemedicine in Germany During the COVID-19 Pandemic: Multi-Professional National Survey

“…A recently published large retrospective study in the United States showed similar results as well for adult step-down or progressive care units, where patients in the telemedical intervention group had a survival benefit of 20% and had a significantly lower length of stay [ 7 ]. Consequently, telemedical solutions are also used for “in-house screening” of patients with COVID-19 (eg, by distributing tablet computers in emergency departments), minimizing the time of direct patient contact and, thus, cutting down the infection risk [ 8 , 9 ]. These findings were supported by a systematic review and meta-analysis of 13 studies involving 35 ICUs using a pre-post-design.…”

Patients’ Perception of Telemedicine in a Large Urban Inner-City Emergency Department: A Cross-Sectional Survey

“…Telemedicine may have the potential to safely ease ED overcrowding, reduce ED ambulance transports, improve ED throughput by integrating specialty services, and decrease the cost of medical care [8,[11][12][13][14][15][16]. Rademacher and colleagues reported that using telemedicine for screening patients in the ED significantly decreased the number of patients left without being seen [17].…”