The Impact of Inpatient Telemedicine on Personal Protective Equipment Savings During the COVID-19 Pandemic: Cross-sectional Study

Implementation of an electronic health record-integrated instant messaging system in an academic health system

OBJECTIVES

Effective communication amongst healthcare workers simultaneously promotes optimal patient outcomes when present and is deleterious to outcomes when absent. The advent of electronic health record (EHR)-embedded secure instantaneous messaging systems has provided a new conduit for provider communication. This manuscript describes the experience of one academic medical center with deployment of one such system (Secure Chat).

METHODS

Data were collected on Secure Chat message volume from June 2017 to April 2023. Significant perideployment events were reviewed chronologically.

RESULTS

After the first coronavirus disease 2019 lockdown in March 2020, messaging use increased by over 25 000 messages per month, with 1.2 million messages sent monthly by April 2023. Comparative features of current communication modalities in healthcare were summarized, highlighting the many advantages of Secure Chat.

CONCLUSIONS

While EHR-embedded secure instantaneous messaging systems represent a novel and potentially valuable communication medium in healthcare, generally agreed-upon best practices for their implementation are, as of yet, undetermined.

A sustainable scheduling system for medical equipment: Towards net zero goals for green healthcare

Shortages of medical equipment, growth in medical waste and carbon emissions have increased healthcare pressures and has a huge impact on the environment. An efficient scheduling of medical equipment will effectively reduce the pressure on healthcare and improve the healthcare system's ability to respond to unexpected disasters. A medical equipment scheduling system was established to improve the sustainable utilization of medical equipment within the healthcare network and to reduce the carbon emissions of the healthcare process. First, this paper combines medical equipment information to establish a medical equipment scheduling decision model that considers pollution to filter qualified medical equipment for scheduling. Then, this paper constructs and solves a multi-objective robust optimization model by collecting the patient's travel information and the medical pressure information of each region. In addition, to meet dynamic healthcare needs, a dynamic medical equipment configuration framework was constructed to enhance the flexibility of equipment scheduling and the resilience of the healthcare network. Combined with case studies, the results show that the medical equipment scheduling system can help decision makers make quick scheduling decisions and achieve sustainable use of medical equipment, with a corresponding increase in medical equipment utilization of 12.25% and a reduction in carbon emissions of 26.50%. The study will help enhance healthcare resource utilization and contribute to the net-zero goal of green healthcare.

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

BACKGROUND

The COVID-19 pandemic prompted widespread implementation of telehealth, including in the inpatient setting, with the goals to reduce potential pathogen exposure events and personal protective equipment (PPE) utilization. Nursing workflow adaptations in these novel environments are of particular interest given the association between nursing time at the bedside and patient safety. Understanding the frequency and duration of nurse-patient encounters following the introduction of a novel telehealth platform in the context of COVID-19 may therefore provide insight into downstream impacts on patient safety, pathogen exposure, and PPE utilization.

OBJECTIVE

The aim of this study was to evaluate changes in nursing workflow relative to prepandemic levels using a real-time locating system (RTLS) following the deployment of inpatient telehealth on a COVID-19 unit.

METHODS

In March 2020, telehealth was installed in patient rooms in a COVID-19 unit and on movable carts in 3 comparison units. The existing RTLS captured nurse movement during 1 pre- and 5 postpandemic stages (January-December 2020). Change in direct nurse-patient encounters, time spent in patient rooms per encounter, and total time spent with patients per shift relative to baseline were calculated. Generalized linear models assessed difference-in-differences in outcomes between COVID-19 and comparison units. Telehealth adoption was captured and reported at the unit level.

RESULTS

Change in frequency of encounters and time spent per encounter from baseline differed between the COVID-19 and comparison units at all stages of the pandemic (all P<.001). Frequency of encounters decreased (difference-in-differences range -6.6 to -14.1 encounters) and duration of encounters increased (difference-in-differences range 1.8 to 6.2 minutes) from baseline to a greater extent in the COVID-19 units relative to the comparison units. At most stages of the pandemic, the change in total time nurses spent in patient rooms per patient per shift from baseline did not differ between the COVID-19 and comparison units (all P>.17). The primary COVID-19 unit quickly adopted telehealth technology during the observation period, initiating 15,088 encounters that averaged 6.6 minutes (SD 13.6) each.

CONCLUSIONS

RTLS movement data suggest that total nursing time at the bedside remained unchanged following the deployment of inpatient telehealth in a COVID-19 unit. Compared to other units with shared mobile telehealth units, the frequency of nurse-patient in-person encounters decreased and the duration lengthened on a COVID-19 unit with in-room telehealth availability, indicating "batched" redistribution of work to maintain total time at bedside relative to prepandemic periods. The simultaneous adoption of telehealth suggests that virtual care was a complement to, rather than a replacement for, in-person care. However, study limitations preclude our ability to draw a causal link between nursing workflow change and telehealth adoption. Thus, further evaluation is needed to determine potential downstream implications on disease transmission, PPE utilization, and patient safety.

Impact of telemedicine on clinical practice patterns for patients with chest pain in the emergency department

Background

The outbreak of the COVID-19 pandemic has led to the rapid adoption of novel telemedicine programs within the emergency department (ED) to minimize provider exposure and conserve personal protective equipment (PPE). In this study, we sought to assess how the adoption of telemedicine in the ED impacted clinical order patterns for patients with chest pain. We hypothesize that clinicians would rely more on imaging and laboratory workup for patients receiving telemedicine due to limitation in physical exams.

Methods

A single-center, retrospective, propensity score matched study was designed for patients presenting with chest pain at an ED. The study period was defined between April 1st, 2020 and September 30th, 2020. The frequency of the most frequent lab, imaging, and medication orders were compared. In addition, poisson regression analysis was performed to compare the overall number of orders between the two groups.

Results

455 patients with chest pain who received telemedicine were matched to 455 similar patients without telemedicine with standardized mean difference < 0.1 for all matched covariates. The proportion of frequent lab, imaging, and medication orders were similar between the two groups. However, telemedicine patients received more orders overall (RR, 1.19, 95% CI, 1.11, 1.28, p-value < 0.001) as well as more imaging, lab, and nursing orders. The number of medication orders between the two groups remained similar.

Conclusions

Frequent labs, imaging, and medications were ordered in similar proportions between the two cohorts. However, telemedicine patients had more orders placed overall. This study is an important objective assessment of the impact that telemedicine has upon clinical practice patterns and can guide future telemedicine implementation after the COVID-19 pandemic.

Ease in Emergency Hospital Visits Due to Covid-19 Following Implementation of a Telemedicine Service in Ceará, Brazil

Background: We assessed the impact of implementing a virtual emergency room (VER) in easing emergency room (ER) visits in patients suspected of having COVID-19. Materials and Methods: Retrospective observational cohort study conducted in May 2020 and in March 2021, during the first and second waves in Brazil. Patients could choose to either visiting ER or using the VER (implemented in March 2021). Medical records were revised for demographic and clinical data. The primary outcome was the number of visits. Results: A total of 32,822 visits were evaluated. HR was more than three times less in the VER group with <10% VER clients going to ER. The trend and volume of use of the emergency sector in the periods did not show a statistically significant difference, despite the higher number of cases in the second period. Conclusion: This telemedicine strategy led to a reduction in visits to the ER. Also, our results suggest the safety of this intervention.

Patient Perspectives of Inpatient Telemedicine During COVID-19: A Qualitative Assessment (Preprint)

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.