School of Social Work, University of Connecticut, Hartford, CT, United States.
Department of Health Care Policy, Harvard Medical School, Boston, MA, United States.
J Med Internet Res. 2020 Dec 17;22(12):e23014. doi: 10.2196/23014.
Older, chronically ill individuals in independent living communities are frequently transferred to the emergency department (ED) for acute issues that could be managed in lower-acuity settings. Triage via telemedicine could deter unnecessary ED transfers.
We examined the effectiveness of a telemedicine intervention for emergency triage in an independent living community.
In the intervention community, a 950-resident independent senior living community, when a resident called for help, emergency medical technician-trained staff could engage an emergency medicine physician via telemedicine to assist with management and triage. We compared trends in the proportion of calls resulting in transport to the ED (ie, primary outcome) in the intervention community to two control communities. Secondary outcomes were telemedicine use and posttransport disposition. Semistructured focus groups of residents and staff were conducted to examine attitudes toward the intervention. Qualitative data analysis used thematic analysis.
Although the service was offered at no cost to residents, use was low and we found no evidence of fewer ED transfers. The key barrier to program use was resistance from frontline staff members, who did not view telemedicine triage as a valuable tool for emergency response, instead perceiving it as time-consuming and as undermining their independent judgment.
Engagement of, and acceptance by, frontline providers is a key consideration in using telemedicine triage to reduce unnecessary ED transfers.
独立生活社区中年龄较大、患有慢性病的个体经常因急性问题被转至急诊部（ED），而这些问题本可以在低危环境中得到处理。通过远程医疗进行分诊可以阻止不必要的 ED 转介。
我们研究了一种用于独立生活社区急诊分诊的远程医疗干预措施的有效性。
在干预社区（一个有 950 名居民的独立高级生活社区），当居民寻求帮助时，经过紧急医疗技术员培训的工作人员可以通过远程医疗联系急诊医学医师，以协助进行管理和分诊。我们比较了干预社区与两个对照社区中因呼叫而导致送往 ED 的比例（即主要结果）的趋势。次要结果是远程医疗的使用和转运后的处置情况。我们对居民和工作人员进行了半结构化焦点小组访谈，以探讨他们对干预措施的态度。定性数据分析采用主题分析。
尽管该服务对居民免费提供，但使用率较低，我们也没有发现 ED 转介减少的证据。该计划使用的主要障碍是一线工作人员的抵制，他们认为远程医疗分诊不是一种有价值的紧急响应工具，反而认为它耗时且破坏了他们的独立判断。
在使用远程医疗分诊来减少不必要的 ED 转介时，与一线服务提供者的互动和接受度是一个关键考虑因素。
