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Jaffe TA, Hayden E, Uscher‐Pines L, Sousa J, Schwamm LH, Mehrotra A, Zachrison KS. Telehealth use in emergency care during coronavirus disease 2019: a systematic review. J Am Coll Emerg Physicians Open 2021; 2:e12443. [PMID: 33969356 PMCID: PMC8087945 DOI: 10.1002/emp2.12443] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 03/21/2021] [Accepted: 03/31/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The coronavirus disease 2019 pandemic has presented emergency departments (EDs) with many challenges to address the acute care needs of patients. Many EDs have leveraged telehealth to innovatively respond to these challenges. This review describes the landscape of telehealth initiatives in emergency care that have been described during the coronavirus disease 2019 pandemic. METHODS We conducted a comprehensive, systematic review of the literature using PubMed, supplemented by a review of the gray literature (ie, non-peer reviewed), with input from subject matter experts to identify telehealth initiatives in emergency care during coronavirus disease 2019. We categorized types of telehealth use based on purpose and user characteristics. RESULTS We included 27 papers from our review of the medical literature and another 8 sources from gray literature review. The vast majority of studies (32/35) were descriptive in nature, with the additional inclusion of 2 cohort studies and one randomized clinical trial. There were 5 categories of ED telehealth use during the pandemic: (1) pre-ED evaluation and screening, (2) within ED (including as a means of limiting staff and patient exposure and facilitating consultation with specialists), (3) post-ED discharge monitoring and treatment, (4) educating trainees and health care workers, and (5) coordinating resources and patient care. CONCLUSION Telehealth has been used in a variety of manners during the coronavirus disease 2019 pandemic, enabling innovation in emergency care delivery. The findings from this study can be used by institutions to consider how telehealth may address challenges in emergency care during the coronavirus disease 2019 pandemic and beyond. Because few studies included cost data and given the variability in institutional resources, how organizations implement telehealth programs will likely vary. Future work should further explore barriers and facilitators of innovation, and the impact on care delivery and patient outcomes.
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Affiliation(s)
- Todd A. Jaffe
- Harvard Affiliated Emergency Medicine ResidencyMassachusetts General Hospital and Brigham and Women's HospitalBostonMassachusettsUSA
| | - Emily Hayden
- Department of Emergency MedicineMassachusetts General HospitalBostonMassachusettsUSA
| | | | | | - Lee H. Schwamm
- Department of NeurologyMassachusetts General HospitalBostonMassachusettsUSA
| | - Ateev Mehrotra
- Department of Health Care PolicyHarvard Medical SchoolBostonMassachusettsUSA
| | - Kori S. Zachrison
- Department of Emergency MedicineMassachusetts General HospitalBostonMassachusettsUSA
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Shah S, Yang GL, Le DT, Gerges C, Wright JM, Parr AM, Cheng JS, Ngwenya LB. Examining the Emergency Medical Treatment and Active Labor Act: impact on telemedicine for neurotrauma. Neurosurg Focus 2020; 49:E8. [PMID: 33130613 DOI: 10.3171/2020.8.focus20587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/18/2020] [Indexed: 11/06/2022]
Abstract
The Emergency Medical Treatment and Active Labor Act (EMTALA) protects patient access to emergency medical treatment regardless of insurance or socioeconomic status. A significant result of the COVID-19 pandemic has been the rapid acceleration in the adoption of telemedicine services across many facets of healthcare. However, very little literature exists regarding the use of telemedicine in the context of EMTALA. This work aimed to evaluate the potential to expand the usage of telemedicine services for neurotrauma to reduce transfer rates, minimize movement of patients across borders, and alleviate the burden on tertiary care hospitals involved in the care of patients with COVID-19 during a global pandemic. In this paper, the authors outline EMTALA provisions, provide examples of EMTALA violations involving neurosurgical care, and propose guidelines for the creation of telemedicine protocols between referring and consulting institutions.
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Affiliation(s)
- Sanjit Shah
- 1Department of Neurological Surgery, University of Cincinnati College of Medicine
| | - George L Yang
- 1Department of Neurological Surgery, University of Cincinnati College of Medicine
| | - Diana T Le
- 2University of Cincinnati College of Medicine, Cincinnati
| | | | - James M Wright
- 3Case Western Reserve University School of Medicine, Cleveland.,4Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio; and
| | - Ann M Parr
- 5Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota
| | - Joseph S Cheng
- 1Department of Neurological Surgery, University of Cincinnati College of Medicine.,2University of Cincinnati College of Medicine, Cincinnati
| | - Laura B Ngwenya
- 1Department of Neurological Surgery, University of Cincinnati College of Medicine.,2University of Cincinnati College of Medicine, Cincinnati
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Turer RW, Jones I, Rosenbloom ST, Slovis C, Ward MJ. Electronic personal protective equipment: A strategy to protect emergency department providers in the age of COVID-19. J Am Med Inform Assoc 2020; 27:967-971. [PMID: 32240303 PMCID: PMC7184500 DOI: 10.1093/jamia/ocaa048] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 03/31/2020] [Indexed: 11/12/2022] Open
Abstract
Emergent policy changes related to telemedicine and the Emergency Medical Treatment and Labor Act during the novel coronavirus disease 2019 (COVID-19) pandemic have created opportunities for technology-based clinical evaluation, which serves to conserve personal protective equipment (PPE) and protect emergency providers. We define electronic PPE as an approach using telemedicine tools to perform electronic medical screening exams while satisfying the Emergency Medical Treatment and Labor Act. We discuss the safety, legal, and technical factors necessary for implementing such a pathway. This approach has the potential to conserve PPE and protect providers while maintaining safe standards for medical screening exams in the emergency department for low-risk patients in whom COVID-19 is suspected.
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Affiliation(s)
- Robert W Turer
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Emergency Medicine, Tennessee Valley Healthcare System VA Medical Center, Nashville, Tennessee, USA
| | - Ian Jones
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - S Trent Rosenbloom
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,School of Nursing, Vanderbilt University, Nashville, Tennessee, USA
| | - Corey Slovis
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Metro Nashville Fire Department, Nashville, Tennessee, USA.,Department of Public Safety, Nashville International Airport, Nashville, Tennessee, USA
| | - Michael J Ward
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Emergency Medicine, Tennessee Valley Healthcare System VA Medical Center, Nashville, Tennessee, USA
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Chou E, Hsieh YL, Wolfshohl J, Green F, Bhakta T. Onsite telemedicine strategy for coronavirus (COVID-19) screening to limit exposure in ED. Emerg Med J 2020; 37:335-337. [PMID: 32366616 DOI: 10.1136/emermed-2020-209645] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 04/16/2020] [Accepted: 04/24/2020] [Indexed: 11/04/2022]
Abstract
Coronavirus (severe acute respiratory syndrome coronavirus 2) outbreak is a public health emergency and a global pandemic. During the present coronavirus disease (COVID-19) crisis, telemedicine has been recommended to screen suspected patients to limit risk of exposure and maximise medical staff protection. We constructed the protective physical barrier with telemedicine technology to limit COVID-19 exposure in ED. Our hospital is an urban community hospital with annual ED volume of approximately 50 000 patients. We equipped our patient exam room with intercom and iPad for telecommunication. Based on our telemedicine screening protocol, physician can conduct a visual physical examination on stable patients via intercom or videoconference. Telemedicine was initially used to overcome the physical barrier between patients and physicians. However, our protocol is designed to create a protective physical barrier to protect healthcare workers and enhance efficiency in ED. The implementation can be a promising protocol in making ED care more cost-effective and efficient during the COVID-19 pandemic and beyond.
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Affiliation(s)
- Eric Chou
- Department of Emergency Medicine, Baylor Scott and White All Saints Medical Center Fort Worth, Fort Worth, Texas, USA
| | - Yu-Lin Hsieh
- Department of Emergency Medicine, Baylor Scott and White All Saints Medical Center Fort Worth, Fort Worth, Texas, USA
| | - Jon Wolfshohl
- Department of Emergency Medicine, Baylor Scott and White All Saints Medical Center Fort Worth, Fort Worth, Texas, USA
| | - Fonda Green
- Department of Emergency Medicine, Baylor Scott and White All Saints Medical Center Fort Worth, Fort Worth, Texas, USA
| | - Toral Bhakta
- Department of Emergency Medicine, Baylor Scott and White All Saints Medical Center Fort Worth, Fort Worth, Texas, USA
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