Using a Real-Time Locating System to Evaluate the Impact of Telemedicine in an Emergency Department During COVID-19: Observational Study

Abstract

Background Telemedicine has been deployed by health care systems in response to the COVID-19 pandemic to enable health care workers to provide remote care for both outpatients and inpatients. Although it is reasonable to suspect telemedicine visits limit unnecessary personal contact and thus decrease the risk of infection transmission, the impact of the use of such technology on clinician workflows in the emergency department is unknown. Objective This study aimed to use a real-time locating system (RTLS) to evaluate the impact of a new telemedicine platform, which permitted clinicians located outside patient rooms to interact with patients who were under isolation precautions in the emergency department, on in-person interaction between health care workers and patients. Methods A pre-post analysis was conducted using a badge-based RTLS platform to collect movement data including entrances and duration of stay within patient rooms of the emergency department for nursing and physician staff. Movement data was captured between March 2, 2020, the date of the first patient screened for COVID-19 in the emergency department, and April 20, 2020. A new telemedicine platform was deployed on March 29, 2020. The number of entrances and duration of in-person interactions per patient encounter, adjusted for patient length of stay, were obtained for pre- and postimplementation phases and compared with t tests to determine statistical significance. Results There were 15,741 RTLS events linked to 2662 encounters for patients screened for COVID-19. There was no significant change in the number of in-person interactions between the pre- and postimplementation phases for both nurses (5.7 vs 7.0 entrances per patient, P=.07) and physicians (1.3 vs 1.5 entrances per patient, P=.12). Total duration of in-person interactions did not change (56.4 vs 55.2 minutes per patient, P=.74) despite significant increases in telemedicine videoconference frequency (0.6 vs 1.3 videoconferences per patient, P<.001 for change in daily average) and duration (4.3 vs 12.3 minutes per patient, P<.001 for change in daily average). Conclusions Telemedicine was rapidly adopted with the intent of minimizing pathogen exposure to health care workers during the COVID-19 pandemic, yet RTLS movement data did not reveal significant changes for in-person interactions between staff and patients under investigation for COVID-19 infection. Additional research is needed to better understand how telemedicine technology may be better incorporated into emergency departments to improve workflows for frontline health care clinicians.

Patient Perspectives of Inpatient Telemedicine During the COVID-19 Pandemic: Qualitative Assessment

“…Increasing sample diversity in terms of languages spoken, given the predominance of English speakers in this sample, may benefit future work. Finally, these qualitative data may also complement and inform ongoing and future quantitative work that explores the impact of inpatient telemedicine on clinician workflows and, by extension, infection control and resource use [ 59 ].…”

Nursing Workflow Change in a COVID-19 Inpatient Unit Following the Deployment of Inpatient Telehealth: Observational Study Using a Real-Time Locating System

“…Only events longer than 5 seconds were recorded in the system. At installation, sensitivity settings were optimized based on the geometric configuration and construction materials, but were not reassessed for this evaluation [ 9 , 18 ].…”

“…Hospital administration and managers encourage all nurses to wear the badges to utilize the system’s beneficial features, including automatic silencing of patient room alarms when a nurse enters a room and a discreet button to call security. Compliance with badge wearing is near universal among nursing staff compared to other members of the clinical team (eg, physicians) [ 9 ]. However, the evaluation team could not and did not confirm that all nurses were compliant during the observation period.…”

“…In the inpatient setting, telehealth was previously used to connect hospitalized patients in rural settings with remote specialists [ 3 ], but has recently expanded to facilitate digital communication between patients and on-site clinicians [ 4 - 6 ]. The impact of inpatient telehealth on infection reduction [ 7 ], clinical workflows [ 8 , 9 ], patient safety [ 10 ], and personal protective equipment (PPE) utilization [ 10 , 11 ] is still under investigation. In the context of a pandemic, telehealth’s impact on infection control and clinical care is of particular interest, although existing evaluations have relied on PPE inventory data and patient and provider satisfaction surveys [ 10 , 11 ].…”

“…Availability of an RTLS provides an opportunity to evaluate the impact of new technologies or clinical circumstances (eg, infectious outbreak) on clinical workflows. A recent study analyzing RTLS data in the emergency setting provided an analytical framework to understand possible clinician workflow adaptations, although no change was ultimately detected in this setting [ 9 ].…”