Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States.
Evaluation Sciences Unit, Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States.
J Med Internet Res. 2021 Jul 26;23(7):e29240. doi: 10.2196/29240.
Telemedicine has been deployed by health care systems in response to the COVID-19 pandemic to enable health care workers to provide remote care for both outpatients and inpatients. Although it is reasonable to suspect telemedicine visits limit unnecessary personal contact and thus decrease the risk of infection transmission, the impact of the use of such technology on clinician workflows in the emergency department is unknown.
This study aimed to use a real-time locating system (RTLS) to evaluate the impact of a new telemedicine platform, which permitted clinicians located outside patient rooms to interact with patients who were under isolation precautions in the emergency department, on in-person interaction between health care workers and patients.
A pre-post analysis was conducted using a badge-based RTLS platform to collect movement data including entrances and duration of stay within patient rooms of the emergency department for nursing and physician staff. Movement data was captured between March 2, 2020, the date of the first patient screened for COVID-19 in the emergency department, and April 20, 2020. A new telemedicine platform was deployed on March 29, 2020. The number of entrances and duration of in-person interactions per patient encounter, adjusted for patient length of stay, were obtained for pre- and postimplementation phases and compared with t tests to determine statistical significance.
There were 15,741 RTLS events linked to 2662 encounters for patients screened for COVID-19. There was no significant change in the number of in-person interactions between the pre- and postimplementation phases for both nurses (5.7 vs 7.0 entrances per patient, P=.07) and physicians (1.3 vs 1.5 entrances per patient, P=.12). Total duration of in-person interactions did not change (56.4 vs 55.2 minutes per patient, P=.74) despite significant increases in telemedicine videoconference frequency (0.6 vs 1.3 videoconferences per patient, P<.001 for change in daily average) and duration (4.3 vs 12.3 minutes per patient, P<.001 for change in daily average).
Telemedicine was rapidly adopted with the intent of minimizing pathogen exposure to health care workers during the COVID-19 pandemic, yet RTLS movement data did not reveal significant changes for in-person interactions between staff and patients under investigation for COVID-19 infection. Additional research is needed to better understand how telemedicine technology may be better incorporated into emergency departments to improve workflows for frontline health care clinicians.
医疗系统在应对 COVID-19 大流行期间部署了远程医疗，以使医护人员能够为门诊和住院患者提供远程护理。虽然合理怀疑远程医疗访问限制了不必要的人员接触，从而降低了感染传播的风险，但尚不清楚此类技术的使用对急诊科临床医生的工作流程的影响。
本研究旨在使用实时定位系统（RTLS）评估一种新的远程医疗平台对医护人员与在急诊科接受隔离预防措施的患者之间的人际互动的影响，该平台允许在病房外的临床医生与患者进行互动。
使用基于徽章的 RTLS 平台进行前后分析，以收集包括护理人员和医生进出急诊病房以及在病房内停留时间在内的移动数据。移动数据于 2020 年 3 月 2 日（急诊科筛查首例 COVID-19 患者之日）至 2020 年 4 月 20 日期间采集。新的远程医疗平台于 2020 年 3 月 29 日推出。根据患者的住院时间，获得每个患者就诊的实际互动次数和持续时间，并进行 t 检验以确定统计学意义。
有 15741 个 RTLS 事件与筛查 COVID-19 的 2662 次患者就诊相关。护士（每次就诊 5.7 次 vs 7.0 次，P=.07）和医生（每次就诊 1.3 次 vs 1.5 次，P=.12）的实际互动次数在实施前后阶段均无显著变化。尽管远程医疗视频会议的频率（每位患者 0.6 次 vs 1.3 次，P<.001 为每日平均变化）和持续时间（每位患者 4.3 分钟 vs 12.3 分钟，P<.001 为每日平均变化）显著增加，但实际互动时间并没有改变（每位患者 56.4 分钟 vs 55.2 分钟）。
在 COVID-19 大流行期间，远程医疗迅速得到采用，目的是尽量减少医护人员接触病原体，但 RTLS 移动数据并未显示出接受 COVID-19 感染调查的工作人员与患者之间的实际互动发生重大变化。需要进一步研究以更好地了解如何将远程医疗技术更好地纳入急诊科，以改善一线临床医护人员的工作流程。
