Division of General Internal Medicine, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, United States.
Department of Surgery, University of Minnesota Medical School, Minneapolis, MN, United States.
J Med Internet Res. 2021 Apr 29;23(4):e25987. doi: 10.2196/25987.
The increasing incidence of COVID-19 infection has challenged health care systems to increase capacity while conserving personal protective equipment (PPE) supplies and minimizing nosocomial spread. Telemedicine shows promise to address these challenges but lacks comprehensive evaluation in the inpatient environment.
The aim of this study is to evaluate an intrahospital telemedicine program (virtual care), along with its impact on exposure risk and communication.
We conducted a natural experiment of virtual care on patients admitted for COVID-19. The primary exposure variable was documented use of virtual care. Patient characteristics, PPE use rates, and their association with virtual care use were assessed. In parallel, we conducted surveys with patients and clinicians to capture satisfaction with virtual care along the domains of communication, medical treatment, and exposure risk.
Of 137 total patients in our primary analysis, 43 patients used virtual care. In total, there were 82 inpatient days of use and 401 inpatient days without use. Hospital utilization and illness severity were similar in patients who opted in versus opted out. Virtual care was associated with a significant reduction in PPE use and physical exam rate. Surveys of 41 patients and clinicians showed high rates of recommendation for further use, and subjective improvements in communication. However, providers and patients expressed limitations in usability, medical assessment, and empathetic communication.
In this pilot natural experiment, only a subset of patients used inpatient virtual care. When used, virtual care was associated with reductions in PPE use, reductions in exposure risk, and patient and provider satisfaction.
COVID-19 感染病例的不断增加给医疗系统带来了挑战，需要在增加容量的同时节约个人防护设备（PPE）供应，并将医院内传播的风险降到最低。远程医疗在应对这些挑战方面显示出了一定的前景，但在住院环境中还缺乏全面的评估。
本研究旨在评估一种院内远程医疗计划（虚拟护理），并评估其对暴露风险和沟通的影响。
我们对因 COVID-19 住院的患者进行了虚拟护理的自然实验。主要暴露变量是记录的虚拟护理使用情况。评估了患者特征、PPE 使用率及其与虚拟护理使用的关系。同时，我们对患者和临床医生进行了调查，以了解他们对虚拟护理在沟通、医疗和暴露风险方面的满意度。
在我们的主要分析中，共有 137 名患者，其中 43 名患者使用了虚拟护理。总共使用了 82 天住院时间，没有使用虚拟护理的时间为 401 天。选择使用虚拟护理的患者与选择不使用虚拟护理的患者在住院利用情况和疾病严重程度方面相似。虚拟护理与 PPE 使用量和体格检查率的显著降低相关。对 41 名患者和临床医生进行的调查显示，推荐进一步使用虚拟护理的比例很高，而且沟通方面也有所改善。然而，提供者和患者表示在可用性、医疗评估和共情沟通方面存在局限性。
在这个试点自然实验中，只有一部分患者使用了住院虚拟护理。当使用虚拟护理时，与 PPE 使用量减少、暴露风险降低以及患者和提供者满意度提高相关。
