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Jung OS, Graetz I, Dorner SC, Hayden EM. Implementing a COVID-19 Virtual Observation Unit in Emergency Medicine: Frontline Clinician and Staff Experiences. Med Care Res Rev 2023; 80:79-91. [PMID: 35815570 PMCID: PMC9806199 DOI: 10.1177/10775587221108750] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The COVID-19 pandemic pushed hospitals to deliver care outside of their four walls. To successfully scale virtual care delivery, it is important to understand how its implementation affects frontline workers, including their teamwork and patient-provider interactions. We conducted in-depth interviews of 17 clinicians and staff involved with the COVID-19 Virtual Observation Unit (CVOU) in the emergency department (ED) of an academic hospital. The program leveraged remote patient monitoring and mobile integrated health care. In the CVOU (vs. the ED), participants observed increases in interactions among clinicians and staff, patient participation in care delivery, attention to nonmedical factors, and involvement of coordinators and paramedics in patient care. These changes were associated with unintended, positive consequences for staff, namely, feeling heard, experience of meaningfulness, and positive attitudes toward virtual care. This study advances research on reconfiguration of roles following implementation of new practices using digital tools, virtual work interactions, and at-home care delivery.
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Affiliation(s)
- Olivia S. Jung
- Emory University, Atlanta, GA,
USA,Harvard University, Cambridge, MA,
USA,Massachusetts General Hospital, Boston,
USA,Olivia S. Jung, Department of Health Policy
and Management, Rollins School of Public Health, Emory University, 1518 Clifton
Road, Atlanta, GA 30322, USA.
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2
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Huang BZ, Creekmur B, Yoo MS, Broder B, Subject C, Sharp AL. Healthcare Utilization Among Patients Diagnosed with COVID-19 in a Large Integrated Health System. J Gen Intern Med 2022; 37:830-837. [PMID: 34993879 PMCID: PMC8735886 DOI: 10.1007/s11606-021-07139-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 09/03/2021] [Indexed: 02/01/2023]
Abstract
Background The demands for healthcare resources following a COVID-19 diagnosis are substantial, but not currently quantified. Objective To describe trends in healthcare utilization within 180 days for patients diagnosed with COVID-19 and identify patient factors associated with increased healthcare use. Design Observational cohort study. Patients A total of 64,011 patients with a test-confirmed COVID-19 diagnosis from March to September 2020 in a large integrated healthcare system in Southern California. Main Measures Overall healthcare utilization during the 180 days following COVID-19 diagnosis, as well as encounter types and reasons for visits during the first 30 days. Poisson regression was used to identify patient factors associated with higher utilization. Analyses were performed separately for patients who were and were not hospitalized for COVID-19. Key Results Healthcare utilization was about twice as high for hospitalized patients compared to non-hospitalized patients in all time periods. The average number of visits was highest in the first 30 days (hospitalized: 12.3 visits/30 person-days; non-hospitalized: 6.6) and gradually decreased over time. In the first 30 days, the majority of healthcare visits were telehealth encounters (hospitalized: 9.0 visits; non-hospitalized: 5.6 visits), and the most prevalent reasons for visits were COVID-related diagnoses, COVID-related symptoms, and respiratory-related conditions. For hospitalized patients, older age (≥65: RR 1.27, 95% CI 1.15–1.41), female gender (RR 1.07, 95% CI 1.05–1.09), and higher BMI (≥40: RR 1.07, 95% CI 1.03–1.10) were associated with higher total utilization. For non-hospitalized patients, older age, female gender, higher BMI, non-white race/ethnicity, former smoking, and greater number of pre-existing comorbidities were all associated with increased utilization. Conclusions Patients with COVID-19 seek healthcare frequently within 30 days of diagnosis, placing high demands on health systems. Identifying ways to support patients diagnosed with COVID-19 while adequately providing the usual recommended care to our communities will be important as we recover from the pandemic. Supplementary Information The online version contains supplementary material available at 10.1007/s11606-021-07139-z.
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Affiliation(s)
- Brian Z. Huang
- grid.280062.e0000 0000 9957 7758Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA USA
- grid.42505.360000 0001 2156 6853Department of Population and Public Health Sciences, Keck School of Medicine of USC, CA Los Angeles, USA
| | - Beth Creekmur
- grid.280062.e0000 0000 9957 7758Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA USA
| | - Michael S. Yoo
- grid.414908.00000 0004 0445 0834The Permanente Medical Group, Kaiser Permanente Santa Rosa Medical Center, Santa Rosa, CA USA
| | - Benjamin Broder
- Southern California Permanente Medical Group, Baldwin Park Medical Center, Baldwin Park, CA USA
| | - Christopher Subject
- grid.414855.90000 0004 0445 0551Southern California Permanente Medical Group, Los Angeles Medical Center, Los Angeles, CA USA
| | - Adam L. Sharp
- grid.280062.e0000 0000 9957 7758Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA USA
- grid.414855.90000 0004 0445 0551Southern California Permanente Medical Group, Los Angeles Medical Center, Los Angeles, CA USA
- grid.19006.3e0000 0000 9632 6718Departments of Clinical Science & Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA USA
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Kuo YS, Lu CH, Chiu PW, Chang HC, Lin YY, Huang SP, Wang PY, Chen CJ, Lin IC, Tang JS, Chang YH, Chang RH, Lin CH. Challenges of Using Instant Communication Technology in the Emergency Department during the COVID-19 Pandemic: A Focus Group Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312463. [PMID: 34886188 PMCID: PMC8656867 DOI: 10.3390/ijerph182312463] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 11/21/2021] [Accepted: 11/23/2021] [Indexed: 11/16/2022]
Abstract
A record outbreak of community-spread COVID-19 started on 10 May 2021, in Taiwan. In response to the COVID-19 pandemic, care facilities have adopted various protocols using instant communication technology (ICT) to provide remote yet timely healthcare while ensuring staff safety. The challenges of patient evaluation in the emergency department (ED) using ICT are seldom discussed in the literature. The objective of this study was to investigate the factors influencing the utility of ICT for patient assessment in emergency settings during the pandemic. The patient flow protocol and the ED layout were modified and regionalized into different areas according to the patient’s risk of COVID-19 infection. Nine iPads were stationed in different zones to aid in virtual patient assessment and communication between medical personnel. A focus group study was performed to assess and analyze the utility of the ICT module in the ED. Eight emergency physicians participated in the study. Of them, four (50%) had been directly involved in the development of the ICT module in the study hospital. Three main themes that influenced the application of the ICT module were identified: setting, hardware, and software. The setting theme included six factors: patient evaluation, subspecialty consultation, patient privacy and comfortableness, sanitation, cost, and patient acceptability. The hardware theme included six factors: internet connection, power, quality of image and voice, public or personal mode, portable or fixed mode, and maintenance. The software theme included six factors: platform choices, security, ICT accounts, interview modes, video/voice recording, and time limitation. Future studies should focus on quantifying module feasibility, user satisfaction, and protocol adjustment for different settings.
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Affiliation(s)
- Yuh-Shin Kuo
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan; (Y.-S.K.); (C.-H.L.); (P.-W.C.); (H.-C.C.); (Y.-Y.L.); (S.-P.H.); (P.-Y.W.); (C.-J.C.); (I.-C.L.); (Y.-H.C.)
| | - Chien-Hsin Lu
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan; (Y.-S.K.); (C.-H.L.); (P.-W.C.); (H.-C.C.); (Y.-Y.L.); (S.-P.H.); (P.-Y.W.); (C.-J.C.); (I.-C.L.); (Y.-H.C.)
| | - Po-Wei Chiu
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan; (Y.-S.K.); (C.-H.L.); (P.-W.C.); (H.-C.C.); (Y.-Y.L.); (S.-P.H.); (P.-Y.W.); (C.-J.C.); (I.-C.L.); (Y.-H.C.)
| | - Hung-Chieh Chang
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan; (Y.-S.K.); (C.-H.L.); (P.-W.C.); (H.-C.C.); (Y.-Y.L.); (S.-P.H.); (P.-Y.W.); (C.-J.C.); (I.-C.L.); (Y.-H.C.)
| | - Yu-Yuan Lin
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan; (Y.-S.K.); (C.-H.L.); (P.-W.C.); (H.-C.C.); (Y.-Y.L.); (S.-P.H.); (P.-Y.W.); (C.-J.C.); (I.-C.L.); (Y.-H.C.)
| | - Shao-Peng Huang
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan; (Y.-S.K.); (C.-H.L.); (P.-W.C.); (H.-C.C.); (Y.-Y.L.); (S.-P.H.); (P.-Y.W.); (C.-J.C.); (I.-C.L.); (Y.-H.C.)
| | - Pei-Yu Wang
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan; (Y.-S.K.); (C.-H.L.); (P.-W.C.); (H.-C.C.); (Y.-Y.L.); (S.-P.H.); (P.-Y.W.); (C.-J.C.); (I.-C.L.); (Y.-H.C.)
| | - Cheng-Jen Chen
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan; (Y.-S.K.); (C.-H.L.); (P.-W.C.); (H.-C.C.); (Y.-Y.L.); (S.-P.H.); (P.-Y.W.); (C.-J.C.); (I.-C.L.); (Y.-H.C.)
| | - I-Chen Lin
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan; (Y.-S.K.); (C.-H.L.); (P.-W.C.); (H.-C.C.); (Y.-Y.L.); (S.-P.H.); (P.-Y.W.); (C.-J.C.); (I.-C.L.); (Y.-H.C.)
| | - Jing-Shia Tang
- Department of Nursing, Chung Hwa University of Medical Technology, Tainan 71703, Taiwan;
- International Doctoral Program in Nursing, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan
| | - Ying-Hsin Chang
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan; (Y.-S.K.); (C.-H.L.); (P.-W.C.); (H.-C.C.); (Y.-Y.L.); (S.-P.H.); (P.-Y.W.); (C.-J.C.); (I.-C.L.); (Y.-H.C.)
| | - Ray Hsienho Chang
- Department of Security and Emergency Services, Embry-Riddle Aeronautical University-Worldwide, Daytona Beach, FL 32114, USA
- Correspondence: (R.H.C.); (C.-H.L.)
| | - Chih-Hao Lin
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan; (Y.-S.K.); (C.-H.L.); (P.-W.C.); (H.-C.C.); (Y.-Y.L.); (S.-P.H.); (P.-Y.W.); (C.-J.C.); (I.-C.L.); (Y.-H.C.)
- Correspondence: (R.H.C.); (C.-H.L.)
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Callagy P, Ravi S, Khan S, Yiadom MYAB, McClellen H, Snell S, Major TW, Yefimova M. Operationalizing a Pandemic-Ready, Telemedicine-Enabled Drive-Through and Walk-In Coronavirus Disease Garage Care System as an Alternative Care Area: A Novel Approach in Pandemic Management. J Emerg Nurs 2021; 47:721-732. [PMID: 34303530 PMCID: PMC8173460 DOI: 10.1016/j.jen.2021.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 05/17/2021] [Accepted: 05/28/2021] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Emergency departments face unforeseen surges in patients classified as low acuity during pandemics such as the coronavirus disease pandemic. Streamlining patient flow using telemedicine in an alternative care area can reduce crowding and promote physical distancing between patients and clinicians, thus limiting personal protective equipment use. This quality improvement project describes critical elements and processes in the operationalization of a telemedicine-enabled drive-through and walk-in garage care system to improve ED throughput and conserve personal protective equipment during 3 coronavirus disease surges in 2020. METHODS Standardized workflows were established for the operationalization of the telemedicine-enabled drive-through and walk-in garage care system for patients presenting with respiratory illness as quality improvement during disaster. Statistical control charts present interrupted time series data on the ED length of stay and personal protective equipment use in the week before and after deployment in March, July, and November 2020. RESULTS Physical space, technology infrastructure, equipment, and staff workflows were critical to the operationalization of the telemedicine-enabled drive-through and walk-in garage care system. On average, the ED length of stay decreased 17%, from 4.24 hours during the week before opening to 3.54 hours during the telemedicine-enabled drive-through and walk-in garage care system operation. There was an estimated 25% to 41% reduction in personal protective equipment use during this time. CONCLUSION Lessons learned from this telemedicine-enabled alternative care area implementation can be used for disaster preparedness and management in the ED setting to reduce crowding, improve throughput, and conserve personal protective equipment during a pandemic.
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Halabi R, Smith G, Sylwestrzak M, Clay B, Longhurst CA, Lander L. The Impact of Inpatient Telemedicine on Personal Protective Equipment Savings During the COVID-19 Pandemic: Cross-sectional Study. J Med Internet Res 2021; 23:e28845. [PMID: 33945494 PMCID: PMC8136403 DOI: 10.2196/28845] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/20/2021] [Accepted: 05/01/2021] [Indexed: 11/19/2022] Open
Abstract
With the emergence of the COVID-19 pandemic and shortage of adequate personal protective equipment (PPE), hospitals implemented inpatient telemedicine measures to ensure operational readiness and a safe working environment for clinicians. The utility and sustainability of inpatient telemedicine initiatives need to be evaluated as the number of COVID-19 inpatients is expected to continue declining. In this viewpoint, we describe the use of a rapidly deployed inpatient telemedicine workflow at a large academic medical center and discuss the potential impact on PPE savings. In early 2020, videoconferencing software was installed on patient bedside iPads at two academic medical center teaching hospitals. An internal website allowed providers to initiate video calls with patients in any patient room with an activated iPad, including both COVID-19 and non–COVID-19 patients. Patients were encouraged to use telemedicine technology to connect with loved ones via native apps or videoconferencing software. We evaluated the use of telemedicine technology on patients’ bedside iPads by monitoring traffic to the internal website. Between May 2020 and March 2021, there were a total of 1240 active users of the Video Visits website (mean 112.7, SD 49.0 connection events per month). Of these, 133 (10.7%) connections were made. Patients initiated 63 (47.4%) video calls with family or friends and sent 37 (27.8%) emails with videoconference connection instructions. Providers initiated a total of 33 (24.8%) video calls with the majority of calls initiated in August (n=22, 67%). There was a low level of adoption of inpatient telemedicine capability by providers and patients. With sufficient availability of PPE, inpatient providers did not find a frequent need to use the bedside telemedicine technology, despite a high census of patients with COVID-19. Compared to providers, patients used videoconferencing capabilities more frequently in September and October 2020. We did not find savings of PPE associated with the use of inpatient telemedicine.
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Affiliation(s)
- Reem Halabi
- School of Medicine, University of California, San Diego, San Diego, CA, United States
| | - Geoffrey Smith
- Information Services, University of California San Diego Health, San Diego, CA, United States
| | - Marc Sylwestrzak
- Information Services, University of California San Diego Health, San Diego, CA, United States
| | - Brian Clay
- Information Services, University of California San Diego Health, San Diego, CA, United States.,Health Sciences Department of Biomedical Informatics, University of California, San Diego, San Diego, CA, United States.,Department of Medicine, University of California, San Diego, San Diego, CA, United States
| | - Christopher A Longhurst
- Information Services, University of California San Diego Health, San Diego, CA, United States.,Health Sciences Department of Biomedical Informatics, University of California, San Diego, San Diego, CA, United States.,Department of Pediatrics, University of California, San Diego, San Diego, CA, United States
| | - Lina Lander
- Information Services, University of California San Diego Health, San Diego, CA, United States.,Department of Family Medicine, University of California, San Diego, La Jolla, CA, United States
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