From the Division of Pediatric Emergency Medicine, Department of Pediatrics, New York City Health and Hospitals, Jacobi Medical Center; Division of Pediatric Emergency Medicine, Departments of.
Department of Emergency Medicine, NewYork-Presbyterian, Weill Cornell Medicine, New York, NY.
Pediatr Emerg Care. 2021 Jul 1;37(7):e417-e420. doi: 10.1097/PEC.0000000000002428.
Prior studies show that staffing a physician at triage expedites care in the emergency department. Our objective was to describe the novel application and effect of a telemedicine medical screening evaluation (Tele-MSE) at triage on quality metrics in the pediatric emergency department (PED).
We conducted a retrospective quasi-experimental pre-post intervention study of patients presenting to an urban PED from December 2017 to November 2019 who received a Tele-MSE at triage. We analyzed 4 diagnostic cohorts: gastroenteritis, psychiatry evaluation, burn injury, and extremity fracture. We matched cases with controls who received standard triage, from December 2015 to November 2017, by age, diagnosis, weekday versus weekend, and season of presentation. Outcome measures included door-to-provider time, time-to-intervention order, and PED length of stay (LOS).
We included 557 patients who received Tele-MSE during the study period. Compared with controls, patients who received a Tele-MSE at triage had a shorter median door-to-provider time (median difference [MD], 8.4 minutes; 95% confidence interval [CI], 6.0-11.0), time-to-medication order (MD, 27.3 minutes; 95% CI, 22.9-35.2), time-to-consult order (MD, 10.0 minutes; 95% CI, 5.3-12.7), and PED LOS (MD, 0.4 hours; 95% CI, 0.3-0.6).
A Tele-MSE is an innovative modality to expedite the initiation of emergency care and reduce PED LOS for children. This novel intervention offers potential opportunities to optimize provider and patient satisfaction and safety during the COVID-19 pandemic.
先前的研究表明，在分诊时配备一名医生可以加快急诊科的治疗速度。我们的目的是描述在分诊时使用远程医疗医疗筛查评估（Tele-MSE）对儿科急诊部（PED）质量指标的新应用和效果。
我们对 2017 年 12 月至 2019 年 11 月期间在城市 PED 就诊并在分诊时接受 Tele-MSE 的患者进行了回顾性准实验前后干预研究。我们分析了 4 个诊断队列：胃肠炎、精神病评估、烧伤和四肢骨折。我们通过年龄、诊断、工作日与周末和就诊季节，将接受标准分诊的病例与 2015 年 12 月至 2017 年 11 月期间的对照组相匹配。结果测量包括从门到提供者的时间、干预医嘱的时间以及 PED 住院时间（LOS）。
我们纳入了在研究期间接受 Tele-MSE 的 557 名患者。与对照组相比，在分诊时接受 Tele-MSE 的患者的中位数门到提供者时间（中位数差异[MD]，8.4 分钟；95%置信区间[CI]，6.0-11.0）、药物医嘱时间（MD，27.3 分钟；95%CI，22.9-35.2）、咨询医嘱时间（MD，10.0 分钟；95%CI，5.3-12.7）和 PED LOS（MD，0.4 小时；95%CI，0.3-0.6）更短。
Tele-MSE 是一种创新的模式，可以加快急诊护理的启动，并减少儿童 PED LOS。这种新的干预措施为在 COVID-19 大流行期间优化提供者和患者满意度和安全性提供了潜在的机会。
