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Coisy F, Olivier G, Ageron FX, Guillermou H, Roussel M, Balen F, Grau-Mercier L, Bobbia X. Do emergency medicine health care workers rate triage level of chest pain differently based upon appearance in simulated patients? Eur J Emerg Med 2024; 31:188-194. [PMID: 38100643 DOI: 10.1097/mej.0000000000001113] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
BACKGROUND AND IMPORTANCE There seems to be evidence of gender and ethnic bias in the early management of acute coronary syndrome. However, whether these differences are related to less severe severity assessment or to less intensive management despite the same severity assessment has not yet been established. OBJECTIVE To show whether viewing an image with characters of different gender appearance or ethnic background changes the prioritization decision in the emergency triage area. METHODS The responders were offered a standardized clinical case in an emergency triage area. The associated image was randomized among eight standardized images of people presenting with chest pain and differing in gender and ethnic appearance (White, Black, North African and southeast Asian appearance). OUTCOME MEASURES AND ANALYSIS Each person was asked to respond to a single clinical case, in which the priority level [from 1 (requiring immediate treatment) to 5 (able to wait up to 2 h)] was assessed visually. Priority classes 1 and 2 for vital emergencies and classes 3-5 for nonvital emergencies were grouped together for analysis. RESULTS Among the 1563 respondents [mean age, 36 ± 10 years; 867 (55%) women], 777 (50%) were emergency physicians, 180 (11%) emergency medicine residents and 606 (39%) nurses. The priority levels for all responses were 1-5 : 180 (11%), 686 (44%), 539 (34%), 131 (9%) and 27 (2%). There was a higher reported priority in male compared to female [62% vs. 49%, difference 13% (95% confidence interval; CI 8-18%)]. Compared to White people, there was a lower reported priority for Black simulated patients [47% vs. 58%, difference -11% (95% CI -18% to -4%)] but not people of southeast Asian [55% vs. 58%, difference -3% (95% CI -10-5%)] and North African [61% vs. 58%, difference 3% (95% CI -4-10%)] appearance. CONCLUSION In this study, the visualization of simulated patients with different characteristics modified the prioritization decision. Compared to White patients, Black patients were less likely to receive emergency treatment. The same was true for women compared with men.
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Affiliation(s)
- Fabien Coisy
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, CHU de Nimes, University of Montpellier, Nimes, France
| | - Guillaume Olivier
- Department of Emergency Medicine, Montpellier University Hospital, Montpellier, France
| | | | - Hugo Guillermou
- IDESP, University of Montpellier and INSERM, Montpellier, France
| | - Mélanie Roussel
- Emergency Department, Rouen University Hospital, Rouen, France
| | - Frédéric Balen
- Emergency Department, Toulouse University Hospital, Toulouse, France
| | - Laura Grau-Mercier
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, CHU de Nimes, University of Montpellier, Nimes, France
| | - Xavier Bobbia
- Montpellier University, UR UM 103 (IMAGINE), Department of Emergency Medicine, Montpellier University Hospital, Montpellier, France
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Mitra A, Veerakone R, Li K, Nix T, Hashikawa A, Mahajan P. Telemedicine in paediatric emergency care: A systematic review. J Telemed Telecare 2023; 29:579-590. [PMID: 34590883 DOI: 10.1177/1357633x211010106] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The impact of telemedicine on the access and quality of paediatric emergency care remains largely unexplored because most studies to date are focused on adult emergency care. We performed a systematic review of the literature to determine if telemedicine is effective in improving quality of paediatric emergency care with regards to access, process measures of care, appropriate disposition, patient-centred outcomes and cost-related outcomes. METHODS We developed a systematic review protocol in accordance with PRISMA (Preferred Reporting Items for Systematic Review) guidelines. We included studies that evaluated the impact of synchronous and asynchronous forms of telemedicine on patient outcomes and process measures in the paediatric emergency care setting. Inclusion criteria were study setting, study design, intervention type, age, outcome measures, publication year and language. RESULTS Overall, 1.9% (28/1434) studies met study inclusion and exclusion criteria. These studies revealed that telemedicine increased accuracy of patient assessment in the pre-clinical setting, improved time-to disposition, guided referring emergency department (ED) physicians in performing appropriate life-saving procedures and led to cost savings when compared to regular care. Studies focused on telepsychiatry demonstrated decreased length of stay (LOS), transfer rates and improved patient satisfaction scores. DISCUSSION Our comprehensive review revealed that telemedicine enhances paediatric emergency care, enhances therapeutic decision-making and improves diagnostic accuracy, and reduces costs. Specifically, telemedicine has its most significant impact on LOS, access to specialized care, cost savings and patient satisfaction. However, there was a relative lack of randomized control trials, and more studies are needed to substantiate its impact on morbidity and mortality.
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Affiliation(s)
- Aditi Mitra
- University of Michigan in Ann Arbor, Michigan
| | | | - Kathleen Li
- Department of Public Health, University of Michigan, USA
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, USA
| | - Tyler Nix
- Taubman Health Sciences Library, University of Michigan, USA
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Chen N, Liu P. Assessing Elderly User Preference for Telehealth Solutions in China: Exploratory Quantitative Study. JMIR Mhealth Uhealth 2022; 10:e27272. [PMID: 35019852 PMCID: PMC8792775 DOI: 10.2196/27272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 07/16/2021] [Accepted: 10/27/2021] [Indexed: 12/26/2022] Open
Abstract
Background In the next 15 to 20 years, the Chinese population will reach a plateau and start to decline. With the changing family structure and rushed urbanization policies, there will be greater demand for high-quality medical resources at urban centers and home-based elderly care driven by telehealth solutions. This paper describes an exploratory study regarding elderly users’ preference for telehealth solutions in the next 5 to 10 years in 4 cities, Shenzhen, Hangzhou, Wuhan, and Yichang. Objective The goal is to analyze why users choose telehealth solutions over traditional health solutions based on a questionnaire study involving 4 age groups (50-60, 61-70, 71-80, and 80+) in 4 cities (Shenzhen, Hangzhou, Wuhan, and Yichang) in the next 10 to 20 years. The legal retirement age for female workers in China is 50 to 55 years and 60 years for male workers. To simulate reality in terms of elderly care in China, the authors use the Chinese definition of elderly for employees, defined as being 50 to 60 years old rather than 65 years, as defined by the World Health Organization. Methods The questionnaires were collected from Shenzhen, Hangzhou, Wuhan, and Yichang randomly with 390 valid data samples. The questionnaire consists of 31 questions distributed offline on tablet devices by local investigators. Subsequently, Stata 16.0 and SPSS 24.0 were used to analyze the data. O-logit ordered regression and principal component analysis (PCA) were the main theoretical models used. The study is currently in the exploratory stage and therefore does not seek generalization of the results. Results Approximately 71.09% (280/390) of the respondents reported having at least 1 type of chronic disease. We started with PCA and categorized all Likert scale variables into 3 factors. The influence of demographic variables on Factors 1, 2, and 3 was verified using analysis of variance (ANOVA) and t tests. The ordered logit regression results suggest that health-related motivations are positively related to the willingness to use telehealth solutions, and trust on data collected from telehealth solutions is negatively correlated with the willingness to use telehealth solutions. Conclusions The findings suggest that there is a need to address the gap in community health care and ensure health care continuity between different levels of health care institutions in China by providing telehealth solutions. Meanwhile, telehealth solution providers must focus on improving users’ health awareness and lower health risk for chronic diseases by addressing lifestyle changes such as regular exercise and social activity. The interoperability between the electronic health record system and telehealth solutions remains a hurdle for telehealth solutions to add value in health care. The hurdle is that doctors neither adjust health care plans nor diagnose based on data collected by telehealth solutions.
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Affiliation(s)
- Nuoya Chen
- Faculty of Global Studies, Justice and Rights, University of Macerata, Macerata, Italy
| | - Pengqi Liu
- Sino-Danish College, University of Chinese Academy of Sciences, Beijing, China
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Soster CB, Anschau F, Rodrigues NH, Silva LGAD, Klafke A. Protocolos de triagem avançada no serviço de emergência: revisão sistemática e metanálise. Rev Lat Am Enfermagem 2022; 30:e3511. [PMID: 35293563 PMCID: PMC8966058 DOI: 10.1590/1518-8345.5479.3511] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 10/01/2021] [Indexed: 11/21/2022] Open
Abstract
Objective To evaluate the effectiveness of using advanced triage protocols on the length of stay, safety and satisfaction of the patients and professionals in the emergency department. Method A systematic review with meta-analysis of randomized clinical trials included in the Embase, BVS, PubMed, CINAHL, Cochrane Library databases and in the gray literature, using Review Manager 5.4. Studies that analyzed length of stay in their outcomes were included and the studies excluded were those that considered other triage protocols. Results 26,672 peer-reviewed studies were found and ten were included in the meta-analysis. For the patients’ length of stay, seven studies were included in the meta-analysis (n=8,229), showing a 36-minute reduction (-0.36[-0.55;-0.17] p=0.002), a result with low certainty of evidence, favorable to the intervention, varying between -0.53 (-0.81;- 0.25) and -0.29 (-0.50;-0.07) in the analysis of the subgroups. Regarding the exams requested, five studies were included (n=2,270), indicating that there is no significant difference between the groups (odds ratio 0.94 [0.64;1.38]). Four studies (n=6,094) analyzed the patients’ and the professionals’ satisfaction, indicating a favorable result to the intervention. Conclusion The advanced triage protocol reduced length of stay in the emergency room without compromising care safety and quality, although more randomized clinical studies on the theme are needed. Registered in PROSPERO (CRD42019142640).
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Affiliation(s)
| | - Fernando Anschau
- Grupo Hospitalar Conceição, Brazil; Pontifícia Universidade Católica do Rio Grande do Sul, Brazil
| | - Nicole Hertzog Rodrigues
- Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil; Santa Casa de Misericórdia de Porto Alegre, Brazil
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Tully L, Case L, Arthurs N, Sorensen J, Marcin JP, O'Malley G. Barriers and Facilitators for Implementing Paediatric Telemedicine: Rapid Review of User Perspectives. Front Pediatr 2021; 9:630365. [PMID: 33816401 PMCID: PMC8010687 DOI: 10.3389/fped.2021.630365] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 02/19/2021] [Indexed: 11/13/2022] Open
Abstract
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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Affiliation(s)
- Louise Tully
- Obesity Research and Care Group, School of Physiotherapy, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Lucinda Case
- W82GO Child and Adolescent Weight Management Service, Children's Health Ireland at Temple Street, Dublin, Ireland
| | - Niamh Arthurs
- W82GO Child and Adolescent Weight Management Service, Children's Health Ireland at Temple Street, Dublin, Ireland
| | - Jan Sorensen
- Healthcare Outcomes Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - James P. Marcin
- Department of Pediatrics, University of California Davis School of Medicine, Sacramento, CA, United States
| | - Grace O'Malley
- Obesity Research and Care Group, School of Physiotherapy, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- W82GO Child and Adolescent Weight Management Service, Children's Health Ireland at Temple Street, Dublin, Ireland
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Chen CH, Wong TY, Chen HC, Huang JF, Wang CJ. Telemedicine communication using instant messaging technology improves pre-hospital triage in high mountain train disasters. HONG KONG J EMERG ME 2020. [DOI: 10.1177/1024907920966530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background:Differences between pre-hospital triage by an emergency medical technician and Simple Triage and Rapid Treatment triage (START) by emergency staffs often affect manpower management and aggravate the chaos condition of emergency room.Objectives:Under the assistance of instant messaging, the authors aimed to identify ways of improving triage differences between emergency medical technician triage grading and Simple Triage and Rapid Treatment triage grading by emergency staffs.Methods:Recorded photographs of all patients were reviewed by a smartphone. We categorized patients according to three triage conditions: group 1, accident scene on-site or instantaneous Simple Triage and Rapid Treatment triage by the emergency medical technician; group 2, triage under Simple Triage and Rapid Treatment grading by emergency staffs; group 3, re-triage with START grading using recorded photographs, Glasgow Coma Scale, and vital signs when these patients were arrived in emergency room. The Wilcoxon Signed-Rank test, Spearman rank correlations, and Kruskal–Wallis test are employed to test differences among the groups. We used risk estimates with odds ratios and the chi-square test to statistically analyze the differences in triage grading.Results:Statistical analysis found conflicting results among Wilcoxon Signed-Rank test, Spearman rank correlations, and Kruskal–Wallis test. The difference in triage grading between groups 2 and 1 was greater than that between groups 2 and 3 (odds ratio, 6.473; 95% confidence interval, 1.693–24.470; p-value < 0.05).Conclusion:Transferred photographs combined with Glasgow Coma Scale and vital signs can help us to understand the real situations of patients. With instant messaging applications, it is possible to make more precise pre-hospital or instantaneous triage.
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Affiliation(s)
- Chia-Hsi Chen
- Department of Emergency Medicine, St. Martin De Porres Hospital, Chiayi
| | - Tak-Yee Wong
- Department of Radiology, St. Martin De Porres Hospital, Chiayi
| | - Hsiu-Chun Chen
- Department of Nursing, St. Martin De Porres Hospital, Chiayi
| | - Jui-Fang Huang
- Department of Education and Research, St. Martin De Porres Hospital, Chiayi
| | - Chung-Jing Wang
- Medical Education and Research Committee, St. Martin De Porres Hospital, Chiayi
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Can telemedicine improve triage and patient satisfaction in urgent care settings? J Am Assoc Nurse Pract 2019; 31:162-166. [DOI: 10.1097/jxx.0000000000000117] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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8
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Towards Health 4.0: e-Hospital Proposal Based Industry 4.0 and Artificial Intelligence Concepts. Artif Intell Med 2019. [DOI: 10.1007/978-3-030-21642-9_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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9
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Delnavaz S, Hassankhani H, Roshangar F, Dadashzadeh A, Sarbakhsh P, Ghafourifard M, Fathiazar E. Comparison of scenario based triage education by lecture and role playing on knowledge and practice of nursing students. NURSE EDUCATION TODAY 2018; 70:54-59. [PMID: 30145535 DOI: 10.1016/j.nedt.2018.08.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 06/18/2018] [Accepted: 08/09/2018] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Quick and accurate triage of patients in the emergency department is a key factor for successful management of the emergency situations and ensuring the quality of care. Moreover, triage skills education is one of the important aspects of preparedness of nurses for different emergency situations. The objective of this study was to compare the effect of educating emergency severity index (ESI) triage using lecture and role-playing on the knowledge and practice of nursing students. METHODS This experimental study was conducted in the School of Nursing and Midwifery, Tabriz, Iran, in 2016. In this study, 56 nursing students were selected by convenience sampling method and were randomly divided into two groups. Triage scenarios were taught and presented in two ways by using lecture or role-playing method. One month later, the post-test was taken. Data were collected using a questionnaire assessing the knowledge and practice of ESI and were analysed using SPSS (version 21). RESULTS The mean knowledge and practice scores in both groups improved significantly (p < 0.05). The post-test score showed a significant difference between the two groups, and the mean score was higher in the role-playing group compared with that of the lecture group (p < 0.05). DISCUSSION The results showed the effectiveness of both educational methods on students' learning. However, the role-playing method was more effective than the lecture method and is recommended for triage education. In addition, according to the importance of triage, developing the theoretical and practical education courses for nursing students is recommended.
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Affiliation(s)
- Samira Delnavaz
- Faculty of Nursing & Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hadi Hassankhani
- Center of Qualitative Studies, Department of Medical Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fariborz Roshangar
- Department of Medical Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Abbas Dadashzadeh
- Department of Medical Surgical Nursing, Faculty of Nursing and Midwifery, Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Parvin Sarbakhsh
- Department of Statistics and Epidemiology, School of Public Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mansour Ghafourifard
- Department of Medical Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Eskandar Fathiazar
- Education & Psychology Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
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Diagnostic accuracy of a rapid telemedicine encounter in the Emergency Department. Am J Emerg Med 2018; 36:2061-2063. [DOI: 10.1016/j.ajem.2018.08.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 08/06/2018] [Accepted: 08/07/2018] [Indexed: 11/23/2022] Open
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One hundred years of clinical laboratory automation: 1967–2067. Clin Biochem 2017; 50:639-644. [DOI: 10.1016/j.clinbiochem.2017.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 03/08/2017] [Accepted: 03/08/2017] [Indexed: 01/05/2023]
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Tolia V, Castillo E, Guss D. EDTITRATE (Emergency Department Telemedicine Initiative to Rapidly Accommodate in Times of Emergency). J Telemed Telecare 2016; 23:484-488. [PMID: 27279469 DOI: 10.1177/1357633x16648535] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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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Affiliation(s)
- Vaishal Tolia
- UCSD Health System, Department of Emergency Medicine, San Diego, California, USA
| | - Eddie Castillo
- UCSD Health System, Department of Emergency Medicine, San Diego, California, USA
| | - David Guss
- UCSD Health System, Department of Emergency Medicine, San Diego, California, USA
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Polinski JM, Barker T, Gagliano N, Sussman A, Brennan TA, Shrank WH. Patients' Satisfaction with and Preference for Telehealth Visits. J Gen Intern Med 2016; 31:269-75. [PMID: 26269131 PMCID: PMC4762824 DOI: 10.1007/s11606-015-3489-x] [Citation(s) in RCA: 350] [Impact Index Per Article: 43.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 07/28/2015] [Indexed: 11/28/2022]
Abstract
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 "very satisfied" with all telehealth attributes. One-third 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, 0.72-0.97). Predictors of liking telehealth were female gender (OR = 1.68, 1.04-2.72) and being very satisfied with their overall understanding of telehealth (OR = 2.76, 1.84-4.15), quality of care received (OR = 2.34, 1.42-3.87), and telehealth's convenience (OR = 2.87, 1.09-7.94) CONCLUSIONS: Patients reported high satisfaction with their telehealth experience. Convenience and perceived quality of care were important to patients, suggesting that telehealth may facilitate access to care.
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Affiliation(s)
| | - Tobias Barker
- CVS Health, 100 Scenic View Drive, #121130, Woonsocket, RI, 02864, USA
| | - Nancy Gagliano
- CVS Health, 100 Scenic View Drive, #121130, Woonsocket, RI, 02864, USA
| | - Andrew Sussman
- CVS Health, 100 Scenic View Drive, #121130, Woonsocket, RI, 02864, USA
| | - Troyen A Brennan
- CVS Health, 100 Scenic View Drive, #121130, Woonsocket, RI, 02864, USA
| | - William H Shrank
- CVS Health, 100 Scenic View Drive, #121130, Woonsocket, RI, 02864, USA
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Traub SJ, Stewart CF, Didehban R, Bartley AC, Saghafian S, Smith VD, Silvers SM, LeCheminant R, Lipinski CA. Emergency Department Rotational Patient Assignment. Ann Emerg Med 2015; 67:206-15. [PMID: 26452721 DOI: 10.1016/j.annemergmed.2015.07.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 06/19/2015] [Accepted: 07/01/2015] [Indexed: 10/23/2022]
Abstract
STUDY OBJECTIVE We compare emergency department (ED) operational metrics obtained in the first year of a rotational patient assignment system (in which patients are assigned to physicians automatically according to an algorithm) with those obtained in the last year of a traditional physician self-assignment system (in which physicians assigned themselves to patients at physician discretion). METHODS This was a pre-post retrospective study of patients at a single ED with no financial incentives for physician productivity. Metrics of interest were length of stay; arrival-to-provider time; rates of left before being seen, left subsequent to being seen, early returns (within 72 hours), and early returns with admission; and complaint ratio. RESULTS We analyzed 23,514 visits in the last year of physician self-assignment and 24,112 visits in the first year of rotational patient assignment. Rotational patient assignment was associated with the following improvements (percentage change): median length of stay 232 to 207 minutes (11%), median arrival to provider time 39 to 22 minutes (44%), left before being seen 0.73% to 0.36% (51%), and complaint ratio 9.0/1,000 to 5.4/1,000 (40%). There were no changes in left subsequent to being seen, early returns, or early returns with admission. CONCLUSION In a single facility, the transition from physician self-assignment to rotational patient assignment was associated with improvement in a broad array of ED operational metrics. Rotational patient assignment may be a useful strategy in ED front-end process redesign.
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Affiliation(s)
- Stephen J Traub
- Department of Emergency Medicine, Mayo Clinic Arizona, Phoenix, AZ; College of Medicine, Mayo Clinic, Rochester, MN.
| | - Christopher F Stewart
- Department of Emergency Medicine, Mayo Clinic Arizona, Phoenix, AZ; College of Medicine, Mayo Clinic, Rochester, MN
| | - Roshanak Didehban
- Department of Emergency Medicine, Mayo Clinic Arizona, Phoenix, AZ; College of Medicine, Mayo Clinic, Rochester, MN
| | - Adam C Bartley
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Soroush Saghafian
- College of Medicine, Mayo Clinic, Rochester, MN; School of Computing, Informatics and Decision Systems Engineering, Arizona State University, Tempe, AZ
| | - Vernon D Smith
- Department of Emergency Medicine, Mayo Clinic Arizona, Phoenix, AZ; College of Medicine, Mayo Clinic, Rochester, MN
| | - Scott M Silvers
- College of Medicine, Mayo Clinic, Rochester, MN; Department of Emergency Medicine, Mayo Clinic Florida, Jacksonville, FL
| | - Ryan LeCheminant
- Department of Emergency Medicine, Mayo Clinic Arizona, Phoenix, AZ
| | - Christopher A Lipinski
- Department of Emergency Medicine, Mayo Clinic Arizona, Phoenix, AZ; College of Medicine, Mayo Clinic, Rochester, MN
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