Kafkas University Faculty of Medicine, Department of Emergency Medicine, Kars, Turkey.
Kafkas University Faculty of Medicine, Department of Infectious Diseases, Kars, Turkey.
JMIR Mhealth Uhealth. 2020 Dec 11;8(12):e22874. doi: 10.2196/22874.
Telephones, internet-connected devices (phablets, personal computers), chat platforms, and mobile apps (eg, Skype, Facebook Messenger, WhatsApp) can be exploited for telemedicine applications. WhatsApp and similar apps are also widely used to facilitate clinical communication between physicians. Moreover, WhatsApp is used by emergency department (ED) physicians and consulting physicians to exchange medical information during ED consultations. This platform is regarded as a useful app in the consultation of dermatological and orthopedic cases. Preventing overcrowding in the ED is key to reducing the risk of disease transmission, and teleconsulting practice is thought to be effective in the diagnosis, treatment, and reduction of transmission risk of disease, most notably during the COVID-19 pandemic. Video consultation is highly recommended in some countries on the grounds that it is likely to reduce the risk of transmission. WhatsApp-like apps are among the video consultation platforms that are assumed to reduce the risk of contamination by minimizing patient-physician contact.
The aim of this study was to investigate the effects of WhatsApp video consultation on patient admission and discharge times in comparison to bedside consultation in the evaluation of potential patients with COVID-19 visiting a COVID-19 outpatient clinic during the pandemic.
Patients who presented to the ED COVID-19 outpatient clinic between March 11 and May 31, 2020, and for whom an infectious disease specialist was consulted (via WhatsApp or at bedside) were included in the study in accordance with the inclusion and exclusion criteria. Eventually, 54 patients whose consultations were performed via WhatsApp and 90 patients whose consultations were performed at bedside were included in our study.
The median length of stay in the ED of discharged patients amounted to 103 minutes (IQR 85-147.75) in the WhatsApp group and 196 minutes (IQR 141-215) in the bedside group. In this regard, the length of stay in the ED was found to be significantly shorter in the WhatsApp group than in the bedside group (P<.001). Among the consulted and discharged patients, 1 patient in each group tested positive for SARS-CoV-2 by polymerase chain reaction test and thus was readmitted and hospitalized (P=.62). The median length of stay of the inpatients in the ED was found to be 116.5 minutes (IQR 85.5-145.5) in the WhatsApp group and 132 minutes (IQR 102-168) in the bedside group. The statistical analysis of this time difference revealed that the length of stay in the ED was significantly shorter for patients in the WhatsApp group than in the bedside group (P=.04).
Consultation via WhatsApp reduces both contact time with patients with COVID-19 and the number of medical staff contacting the patients, which contributes greatly to reducing the risk of COVID-19 transmission. WhatsApp consultation may prove useful in clinical decision making as well as in shortening process times. Moreover, it does not result in a decreased accuracy rate. The shortened discharge and hospitalization timespans also decreased the length of stay in the ED, which can have an impact on minimizing ED crowding.
ClinicalTrials.gov NCT04645563; https://clinicaltrials.gov/ct2/show/NCT04645563.
电话、互联网连接设备（平板电脑、个人电脑）、聊天平台和移动应用程序（如 Skype、Facebook Messenger、WhatsApp）可用于远程医疗应用。WhatsApp 等应用程序也被广泛用于促进医生之间的临床沟通。此外，急诊科（ED）医生和会诊医生使用 WhatsApp 在 ED 会诊期间交换医疗信息。该平台被认为在皮肤科和骨科病例的会诊中是有用的应用程序。减少 ED 拥挤是降低疾病传播风险的关键，远程咨询实践被认为在 COVID-19 大流行期间对疾病的诊断、治疗和降低传播风险有效。一些国家强烈建议进行视频咨询，理由是这可能降低传播风险。类似于 WhatsApp 的应用程序被认为通过最大限度地减少医患接触来降低污染风险，是减少污染风险的视频咨询平台之一。
本研究旨在调查 WhatsApp 视频咨询与床边咨询相比对 COVID-19 门诊评估疑似 COVID-19 患者入院和出院时间的影响。
根据纳入和排除标准，纳入 2020 年 3 月 11 日至 5 月 31 日期间到 ED COVID-19 门诊就诊并接受传染病专家咨询（通过 WhatsApp 或床边）的患者。最终，共有 54 名通过 WhatsApp 咨询的患者和 90 名通过床边咨询的患者纳入本研究。
WhatsApp 组出院患者在 ED 的中位住院时间为 103 分钟（IQR 85-147.75），床边组为 196 分钟（IQR 141-215）。在这方面，WhatsApp 组的 ED 住院时间明显短于床边组（P<.001）。在接受咨询和出院的患者中，每组各有 1 名患者经聚合酶链反应检测 SARS-CoV-2 检测呈阳性，因此再次入院并住院（P=.62）。WhatsApp 组 ED 住院患者的中位住院时间为 116.5 分钟（IQR 85.5-145.5），床边组为 132 分钟（IQR 102-168）。对这一时间差异的统计分析表明，WhatsApp 组患者的 ED 住院时间明显短于床边组（P=.04）。
通过 WhatsApp 进行咨询可减少与 COVID-19 患者的接触时间和接触患者的医务人员数量，这对降低 COVID-19 传播风险大有帮助。WhatsApp 咨询可能有助于临床决策，并缩短处理时间。此外，它不会导致准确率降低。缩短出院和住院时间也缩短了 ED 的住院时间，从而有助于减少 ED 拥挤。
ClinicalTrials.gov NCT04645563；https://clinicaltrials.gov/ct2/show/NCT04645563.
