Lin Chien-Hao, Tseng Wen-Pin, Wu Jhong-Lin, Tay Joyce, Cheng Ming-Tai, Ong Hooi-Nee, Lin Hao-Yang, Chen Yi-Ying, Wu Chih-Hsien, Chen Jiun-Wei, Chen Shey-Ying, Chan Chang-Chuan, Huang Chien-Hua, Chen Shyr-Chyr
Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei, Taiwan.
J Med Internet Res. 2020 Jun 23;22(6):e20586. doi: 10.2196/20586.
Frontline health care workers, including physicians, are at high risk of contracting coronavirus disease (COVID-19) owing to their exposure to patients suspected of having COVID-19.
The aim of this study was to evaluate the benefits and feasibility of a double triage and telemedicine protocol in improving infection control in the emergency department (ED).
In this retrospective study, we recruited patients aged ≥20 years referred to the ED of the National Taiwan University Hospital between March 1 and April 30, 2020. A double triage and telemedicine protocol was developed to triage suggested COVID-19 cases and minimize health workers' exposure to this disease. We categorized patients attending video interviews into a telemedicine group and patients experiencing face-to-face interviews into a conventional group. A questionnaire was used to assess how patients perceived the quality of the interviews and their communication with physicians as well as perceptions of stress, discrimination, and privacy. Each question was evaluated using a 5-point Likert scale. Physicians' total exposure time and total evaluation time were treated as primary outcomes, and the mean scores of the questions were treated as secondary outcomes.
The final sample included 198 patients, including 93 cases (47.0%) in the telemedicine group and 105 cases (53.0%) in the conventional group. The total exposure time in the telemedicine group was significantly shorter than that in the conventional group (4.7 minutes vs 8.9 minutes, P<.001), whereas the total evaluation time in the telemedicine group was significantly longer than that in the conventional group (12.2 minutes vs 8.9 minutes, P<.001). After controlling for potential confounders, the total exposure time in the telemedicine group was 4.6 minutes shorter than that in the conventional group (95% CI -5.7 to -3.5, P<.001), whereas the total evaluation time in the telemedicine group was 2.8 minutes longer than that in the conventional group (95% CI -1.6 to -4.0, P<.001). The mean scores of the patient questionnaire were high in both groups (4.5/5 to 4.7/5 points).
The implementation of the double triage and telemedicine protocol in the ED during the COVID-19 pandemic has high potential to improve infection control.
包括医生在内的一线医护人员由于接触疑似感染新型冠状病毒肺炎（COVID-19）的患者，感染该疾病的风险很高。
本研究旨在评估双重分诊和远程医疗方案在改善急诊科（ED）感染控制方面的益处和可行性。
在这项回顾性研究中，我们招募了2020年3月1日至4月30日期间转诊至台湾大学附属医院急诊科的年龄≥20岁的患者。制定了双重分诊和远程医疗方案，以对疑似COVID-19病例进行分诊，并尽量减少医护人员接触该疾病的机会。我们将参加视频访谈的患者归为远程医疗组，将接受面对面访谈的患者归为传统组。使用问卷评估患者对访谈质量、与医生沟通的感受以及对压力、歧视和隐私的看法。每个问题采用5分李克特量表进行评估。医生的总暴露时间和总评估时间作为主要结果，问题的平均得分作为次要结果。
最终样本包括198名患者，其中远程医疗组93例（47.0%），传统组105例（53.0%）。远程医疗组的总暴露时间明显短于传统组（4.7分钟对8.9分钟，P<0.001），而远程医疗组的总评估时间明显长于传统组（12.2分钟对8.9分钟，P<0.001）。在控制潜在混杂因素后，远程医疗组的总暴露时间比传统组短4.6分钟（95%CI -5.7至-3.5，P<0.001），而远程医疗组的总评估时间比传统组长2.8分钟（95%CI -1.6至-4.0，P<0.001）。两组患者问卷的平均得分都很高（4.5/5至4.7/5分）。
在COVID-19大流行期间，在急诊科实施双重分诊和远程医疗方案具有很大潜力来改善感染控制。
