1
|
Wray CM, Junge M, Keyhani S, Smith JE. Assessment of a multi-center tele-urgent care program to decrease emergency department referral rates in the Veterans Health Administration. J Telemed Telecare 2023; 29:749-754. [PMID: 34152876 DOI: 10.1177/1357633x211024843] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The use of emergency departments for non-emergent issues has led to overcrowding and decreased the quality of care. Telemedicine may be a mechanism to decrease overutilization of this expensive resource. From April to September 2020, we assessed (a) the impact of a multi-center tele-urgent care program on emergency department referral rates and (b) the proportion of individuals who had a subsequent emergency department visit within 72 h of tele-urgent care evaluation when they were not referred to the emergency department. We then performed a chart review to assess whether patients presented to the emergency department for the same reason as was stated for their tele-urgent care evaluation, whether subsequent hospitalization was needed during that emergency department visit, and whether death occurred. Among the 2510 patients who would have been referred to in-person emergency department care, but instead received tele-urgent care assessment, one in five (21%; n = 533) were subsequently referred to the emergency department. Among those not referred following tele-urgent care, 1 in 10 (11%; n = 162) visited the emergency department within 72 h. Among these 162 individuals, most (91%) returned with the same or similar complaint as what was assessed during their tele-urgent care visit, with one in five requiring hospitalization (19%, n = 31) with one individual (0.01%) dying. In conclusion, tele-urgent care may safely decrease emergency department utilization.
Collapse
Affiliation(s)
- Charlie M Wray
- Department of Medicine, University of California, San Francisco, USA
- Section of Hospital Medicine, San Francisco Veterans Affairs Medical Center, USA
| | - Myla Junge
- Section of Emergency Medicine, San Francisco Veterans Affairs Medical Center, USA
| | - Salomeh Keyhani
- Department of Medicine, University of California, San Francisco, USA
- Section of General Internal Medicine, San Francisco Veterans Affairs Medical Center, USA
| | - Janeen E Smith
- Department of Medicine, University of California, San Francisco, USA
- Section of Emergency Medicine, San Francisco Veterans Affairs Medical Center, USA
| |
Collapse
|
2
|
Avila FR, Carter RE, McLeod CJ, Bruce CJ, Guliyeva G, Torres-Guzman RA, Maita KC, Ho OA, TerKonda SP, Forte AJ. The Role of Telemedicine in Prehospital Traumatic Hand Injury Evaluation. Diagnostics (Basel) 2023; 13:diagnostics13061165. [PMID: 36980474 PMCID: PMC10047211 DOI: 10.3390/diagnostics13061165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/11/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
Unnecessary ED visits and transfers to hand clinics raise treatment costs and patient burden at trauma centers. In the present COVID-19 pandemic, needless transfers can increase patients' risk of viral exposure. Therefore, this review analyzes different aspects of the remote diagnosis and triage of traumatic hand injuries. The most common file was photography, with the most common devices being cell phone cameras. Treatment, triage, diagnosis, cost, and time outcomes were assessed, showing concordance between teleconsultation and face-to-face patient evaluations. We conclude that photography and video consultations are feasible surrogates for ED visits in patients with traumatic hand injuries. These technologies should be leveraged to decrease treatment costs and potentially decrease the time to definitive treatment after initial evaluation.
Collapse
Affiliation(s)
- Francisco R Avila
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, USA
| | - Rickey E Carter
- Department of Quantitative Health Sciences, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, USA
| | - Christopher J McLeod
- Department of Cardiovascular Medicine, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, USA
| | - Charles J Bruce
- Department of Cardiovascular Medicine, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, USA
| | - Gunel Guliyeva
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | | | - Karla C Maita
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, USA
| | - Olivia A Ho
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, USA
| | - Sarvam P TerKonda
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, USA
| | - Antonio J Forte
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, USA
| |
Collapse
|
3
|
Benjamin P, Bryce R, Oyedokun T, Stempien J. Strength in the gap: A rapid review of principles and practices for urgent care centres. Healthc Manage Forum 2023; 36:101-106. [PMID: 36519425 PMCID: PMC9976643 DOI: 10.1177/08404704221143300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Responding to a provincial government decision to develop two Urgent Care Centres (UCCs) in Saskatchewan, we undertook a rapid review of published literature with the objective of determining best practices for their creation and functioning. Two English-limited PubMed database searches combining "after-hours care," "ambulatory care," "emergency medicine," "urgent care," "minor emergency," "walk-in," and "Canada" over the past 10 years were the sources of articles for our review. Articles were independently reviewed by two authors and synthesized collaboratively. From 833 articles, 44 were utilized in the review. Six considerations in the following areas were subsequently outlined: expected impact, preferred location, healthcare services collaboration, available services, staffing priorities, and community partnerships. These principles were considered against the backdrop of currently successful Canadian UCCs. This review indicates that general principles for the successful development of UCCs exist; these may guide the establishment and functioning of UCCs both in Saskatchewan and elsewhere.
Collapse
Affiliation(s)
- Ponn Benjamin
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Rhonda Bryce
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada.,Rhonda Bryce, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. E-mail:
| | | | - James Stempien
- Royal University Hospital, Saskatoon, Saskatchewan, Canada
| |
Collapse
|
4
|
Saxena V, Bahurupi Y, Mishra A, Singh A, Parate S, Sandhu H. Strength, Weakness, Opportunities, and Threats (SWOT) Analysis of Virtual Outpatient Department Under Telemedicine Department During the COVID-19 Pandemic. Cureus 2022; 14:e22476. [PMID: 35371781 PMCID: PMC8943442 DOI: 10.7759/cureus.22476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2022] [Indexed: 11/21/2022] Open
Abstract
Background COVID-19 pandemic has challenged all current management tools used for patient care. This study aims to determine strength, weakness, opportunities and threats (SWOT) to virtual OPD and consultants' perceptions of teleconsultation virtual OPD during the COVID-19 pandemic, adapting to newer technologies for successfully handling this situation. Material and methods A facility-based cross-sectional study was conducted at the Virtual OPD of All India Institute of Medical Sciences Rishikesh among patients availing Telemedicine consultation during the COVID-19 pandemic. All patients availing services from April 2020 to October 2020 were included in this study. Method for SWOT analysis: A checklist was prepared, and investigators assessed SWOT. An external evaluator was invited to evaluate the SWOT analysis conducted by the investigators. For numeric variables, the mean ± SD was used, and for categorical variables, percentages and proportions were used. Results Around 22% of the patients who approached virtual OPDs were ≥ 60 years of age. More than half (55.3%) of the patients or their attendants who consulted Telemedicine OPD were from Uttarakhand, followed by Uttar Pradesh (42.6%). The proportions of male patients were 54.4%. Around 17.6% of teleconsultations were performed for radiotherapy. General medicine and cardiology consultations were (15.2%) and (12.8%), respectively. Conclusion Telemedicine can be effective if certain requirements had been provided. Maintaining privacy of the patient's data was a challenge.
Collapse
|
5
|
Vilendrer S, Sackeyfio S, Akinbami E, Ghosh R, Luu JH, Pathak D, Shimada M, Williamson EE, Shieh L. Patient Perspectives of Inpatient Telemedicine During COVID-19: A Qualitative Assessment (Preprint). JMIR Form Res 2021; 6:e32933. [PMID: 35147510 PMCID: PMC8970158 DOI: 10.2196/32933] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 01/26/2022] [Accepted: 01/27/2022] [Indexed: 01/23/2023] Open
Abstract
Background Telemedicine has been adopted in the inpatient setting to facilitate clinical interactions between on-site clinicians and isolated hospitalized patients. Such remote interactions have the potential to reduce pathogen exposure and use of personal protective equipment but may also pose new safety concerns given prior evidence that isolated patients can receive suboptimal care. Formal evaluations of the use and practical acceptance of inpatient telemedicine among hospitalized patients are lacking. Objective We aimed to evaluate the experience of patients hospitalized for COVID-19 with inpatient telemedicine introduced as an infection control measure during the pandemic. Methods We conducted a qualitative evaluation in a COVID-19 designated non–intensive care hospital unit at a large academic health center (Stanford Health Care) from October 2020 through January 2021. Semistructured qualitative interviews focused on patient experience, impact on quality of care, communication, and mental health. Purposive sampling was used to recruit participants representing diversity across varying demographics until thematic saturation was reached. Interview transcripts were qualitatively analyzed using an inductive-deductive approach. Results Interviews with 20 hospitalized patients suggested that nonemergency clinical care and bridging to in-person care comprised the majority of inpatient telemedicine use. Nurses were reported to enter the room and call on the tablet far more frequently than physicians, who typically entered the room at least daily. Patients reported broad acceptance of the technology, citing improved convenience and reduced anxiety, but preferred in-person care where possible. Quality of care was believed to be similar to in-person care with the exception of a few patients who wanted more frequent in-person examinations. Ongoing challenges included low audio volume, shifting tablet location, and inconsistent verbal introductions from the clinical team. Conclusions Patient experiences with inpatient telemedicine were largely favorable. Although most patients expressed a preference for in-person care, telemedicine was acceptable given the circumstances associated with the COVID-19 pandemic. Improvements in technical and care team use may enhance acceptability. Further evaluation is needed to understand the impact of inpatient telemedicine and the optimal balance between in-person and virtual care in the hospital setting.
Collapse
Affiliation(s)
- Stacie Vilendrer
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, United States
| | - Sarah Sackeyfio
- Department of Physics, Stanford University, Stanford, CA, United States
| | - Eliel Akinbami
- Department of Bioengineering, Stanford University, Stanford, CA, United States
| | - Roy Ghosh
- Department of Bioengineering, Stanford University, Stanford, CA, United States
| | - Jacklyn Ha Luu
- Department of Bioinformatics, Stanford University School of Medicine, Stanford, CA, United States
| | - Divya Pathak
- Department of Biochemistry, Stanford University, Stanford, CA, United States
| | - Masahiro Shimada
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, United States
| | | | - Lisa Shieh
- Division of Hospital Medicine, Stanford University School of Medicine, Stanford, CA, United States
| |
Collapse
|
6
|
Het gebruik van videobeelden bij triage op de huisartsenpost. ACTA ACUST UNITED AC 2021; 64:42-44. [PMID: 34376860 PMCID: PMC8336669 DOI: 10.1007/s12445-021-1240-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Bij een deel van de patiënten die de huisartsenpost bellen, kunnen triagisten de klacht niet goed beoordelen omdat ze de patiënt niet kunnen zien. Dan wordt er een consult afgesproken, terwijl dat achteraf niet altijd nodig bleek te zijn. Het gebruik van videobeelden kan dit probleem mogelijk oplossen, maar er zijn vragen over de toegevoegde waarde van deze methode. In dit artikel geven we antwoord op vragen als: hoe vaak worden videobeelden ingezet bij triage, wat is daarvoor de indicatie en is het gebruik doelmatig, effectief en veilig?
Collapse
|
7
|
Portnoy JM, Pandya A, Waller M, Elliott T. Telemedicine and emerging technologies for health care in allergy/immunology. J Allergy Clin Immunol 2020; 145:445-454. [PMID: 32035604 DOI: 10.1016/j.jaci.2019.12.903] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 12/23/2019] [Accepted: 12/23/2019] [Indexed: 12/15/2022]
Abstract
Telemedicine (TM) has become a popular method of accessing medical services between providers and patients and is viewed as a cost-effective alternative to more traditional episodic face-to-face encounters. TM overcomes 2 barriers that patients face when seeking health care: distance and time. It is as effective as in-person visits for outpatient treatment of asthma, and it is a convenient way to provide inpatient consultations for patients when the allergist practices outside of the hospital. TM also has been used to manage patients with asthma in schools. Patients tend to be as satisfied with TM or they prefer TM over in-person visits, but infrequently they do prefer in-person visits. In addition to virtual visits using TM, there are several emerging technologies that are relevant to the practice of allergy/immunology including electronic diaries (eg, symptoms and medication use), wearable technology (eg, to monitor activity and vital signs), remote patient monitoring (eg, environmental exposures and medication adherence) as well as electronic medical records augmented with clinical decision support. We believe that the use of TM, particularly when combined with information technologies such as electronic health records, has the potential to cause a transformational change in the way care is delivered by altering the process of interaction between patient and provider. TM addresses the shortage of allergy specialists in rural and underserved urban communities and facilitates patient access to allergy services. As patients take more control of their health care, use of TM is likely to increase because a large part of the move to adopt TM is driven by patient preference.
Collapse
|
8
|
Al-Ruzzieh MA, Ayaad O, Qaddumi B. The role of e-health in improving control and management of COVID 19 outbreak: current perspectives. Int J Adolesc Med Health 2020; 34:139-145. [PMID: 32866117 DOI: 10.1515/ijamh-2020-0072] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 05/05/2020] [Indexed: 12/20/2022]
Abstract
E-health could play an important role in the global response to Coronavirus disease 2019 (COVID-19). This paper aims to outline the roles of using e-health in the control and management of COVID-19 based on current perspectives. Many databases and health organizations were searched. The results indicated that there are significant roles of e-health in strengthening the efforts to control and manage this COVID-19 pandemic through improving safe coordination and communication, affording an alternative for education and training, analyzing the data, and providing safe care. Further studies are recommended to evaluate the role of e-health in the control and management of COVID-19.
Collapse
Affiliation(s)
| | - Omar Ayaad
- King Hussein Cancer Center, Amman, Jordan
| | | |
Collapse
|
9
|
Abstract
Social distancing as a technique to limit transmission of infectious disease has come into common parlance following the arrival and rapid spread of a novel coronavirus disease around the world in 2019 and 2020. But in the face of an emerging pandemic threat, it is crucial that we start to apply these principles to the clinic, the emergency department, and the hospital ward. We propose that this dynamic situation calls for a parallel "Clinical Distancing" in which we as a medical culture go against many of our fundamental instincts and, at least in the short term, begin to reduce unnecessary patient-care contacts for the benefit of our patients and our ability to continue to provide care to those who need it most. In this commentary, we provide specific recommendations for the rapid implementation of clinical distancing techniques.
Collapse
Affiliation(s)
- Benjamin K Scott
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO
| | | | - Jeremy C Pamplin
- United States Army Telemedicine and Advanced Technology Research Center, Frederick, MD
- Uniformed Services University, Bethesda, MD
| |
Collapse
|