Department of Emergency Medicine, Georgetown University School of Medicine, Washington, DC; Georgetown Emergency Medicine Residency, MedStar Georgetown University Hospital / MedStar Washington Hospital Center, Washington, DC.
Georgetown Emergency Medicine Residency, MedStar Georgetown University Hospital / MedStar Washington Hospital Center, Washington, DC.
J Emerg Med. 2020 Dec;59(6):957-963. doi: 10.1016/j.jemermed.2020.08.007. Epub 2020 Aug 7.
Telemedicine is uniquely positioned to address challenges posed to emergency departments (EDs) by the Coronavirus Disease 2019 (COVID-19) pandemic. By reducing in-person contact, it should decrease provider risk of infection and preserve personal protective equipment (PPE).
To describe and assess the early results of a novel telehealth workflow in which remote providers collaborate with in-person nursing to evaluate and discharge well-appearing, low-risk ED patients with suspected COVID-19 infection.
Retrospective chart review was completed 3 weeks after implementation. Metrics include the number of patients evaluated, number of patients discharged without in-person contact, telehealth wait time and duration, collection of testing, ED length of stay (ED-LOS), 72-h return, number of in-person health care provider contacts, and associated PPE use.
Among 302 patients evaluated by telehealth, 153 patients were evaluated and discharged by a telehealth provider with reductions in ED-LOS, PPE use, and close contact with health care personnel. These patients had a 62.5% shorter ED-LOS compared with other Emergency Severity Index level 4 patients seen over the same time period. Telehealth use for these 153 patients saved 413 sets of PPE. We observed a 3.9% 72-h revisit rate. One patient discharged after telehealth evaluation was hospitalized on a return visit 9 days later.
Telehealth can be safely and efficiently used to evaluate, treat, test, and discharge ED patients suspected to have COVID-19. This workflow reduces infection risks to health care providers, PPE use, and ED-LOS. Additionally, it allows quarantined but otherwise well clinicians to continue working.
远程医疗在应对 2019 年冠状病毒病（COVID-19）大流行给急诊科（ED）带来的挑战方面具有独特的优势。通过减少人际接触，它应该降低提供者感染的风险，并保护个人防护设备（PPE）。
描述和评估一种新的远程医疗工作流程的早期结果，该流程使远程提供者与现场护理人员合作，评估和出院表现良好、低风险的 ED 疑似 COVID-19 感染患者。
在实施后 3 周完成回顾性图表审查。评估的指标包括评估的患者人数、无需面对面接触即可出院的患者人数、远程医疗等待时间和持续时间、检测采集、ED 住院时间（ED-LOS）、72 小时复诊、面对面卫生保健提供者的接触次数以及相关的 PPE 使用情况。
在通过远程医疗评估的 302 名患者中，有 153 名患者由远程医疗提供者进行评估和出院，这降低了 ED-LOS、PPE 使用和与医务人员的密切接触。这些患者的 ED-LOS 比同一时期接受的其他紧急严重指数 4 级患者短 62.5%。为这 153 名患者使用远程医疗节省了 413 套 PPE。我们观察到 3.9%的 72 小时复诊率。一名在远程医疗评估后出院的患者在 9 天后的复诊中住院。
远程医疗可以安全有效地用于评估、治疗、检测和出院疑似 COVID-19 的 ED 患者。该工作流程降低了卫生保健提供者感染风险、PPE 使用和 ED-LOS。此外，它允许被隔离但情况良好的临床医生继续工作。
