Fawcett Kelsey, Stimell-Rauch Mindy, Wagh Anju, Fenster Daniel, Kessler David, DePeter Kerrin, Kim Ji Won, Lame Maria, Sonnett Meridith, Bregstein Joan
Pediatric Emergency Medicine, Vagelos College of Physicians and Surgeons, New York Presbyterian Morgan Stanley Children's Hospital, New York, USA.
Pediatric Emergency Medicine, Weill-Cornell College of Medicine, New York Presbyterian Komansky Children's Hospital, New York, USA.
Cureus. 2022 Jun 21;14(6):e26145. doi: 10.7759/cureus.26145. eCollection 2022 Jun.
Our objectives were to assess the comfort level of pediatric emergency physicians (PEPs) providing urgent care to adult patients on telemedicine (APOTM) when redeployed during the coronavirus disease 2019 (COVID-19) pandemic, how it changed over time, and what resources were helpful. Materials and methods: We conducted a retrospective pre-post cross-sectional survey of PEPs providing urgent care to APOTM with COVID-19 symptoms during the COVID-19 surge from March 12, 2020, to June 12, 2020 (the "care period") at two academic pediatric emergency departments in New York City. A retrospective chart review was also conducted. We include data on demographics of PEPs and adult patients; comfort level of PEPs providing urgent care to APOTM with COVID-19 symptoms pre- and post-three-month care period and effective resources.
Sixty-five PEPs provided urgent care to 1515 APOTM with COVID-19 symptoms during the care period. Pre-pandemic, 22/43 (51%) of responders feared caring for APOTM; 6/43 (14%) were comfortable. At the end of the care period, 25/42 (58%) of the responders stated they were comfortable caring for these patients. Factors associated with increased comfort level were: increased volume of patients over time, treatment algorithms, group support via electronic communication, and real-time back-up by a general emergency medicine (GEM) physician. Reduced medicolegal liability was also cited.
With minimal additional training and resources, PEPs can increase their comfort to provide urgent care to APOTM with COVID-19 symptoms. As future pandemics may disproportionately affect certain patient populations (adults versus pediatrics), interventions such as treatment algorithms, group support via emails and texts, and sub-specialty backup should be incorporated into redeployment plans for urgent care telemedicine programs. Future research is needed to determine the adaptability of other medical specialties to cross-cover a different specialty from their own if needed.
我们的目标是评估在2019年冠状病毒病（COVID-19）大流行期间被重新部署时，为成年患者提供远程医疗紧急护理（APOTM）的儿科急诊医生（PEP）的舒适度水平，其随时间的变化情况，以及哪些资源是有帮助的。材料和方法：我们在纽约市的两个学术性儿科急诊科，对在2020年3月12日至2020年6月12日（“护理期”）的COVID-19激增期间为有COVID-19症状的APOTM提供紧急护理的PEP进行了一项回顾性前后横断面调查。还进行了回顾性病历审查。我们纳入了关于PEP和成年患者人口统计学的数据；在为期三个月的护理期前后，为有COVID-19症状的APOTM提供紧急护理的PEP的舒适度水平以及有效的资源。
在护理期内，65名PEP为1515名有COVID-19症状的APOTM提供了紧急护理。在大流行之前，22/43（51%）的受访者担心护理APOTM；6/43（14%）感到舒适。在护理期结束时，25/42（58%）的受访者表示他们对护理这些患者感到舒适。与舒适度提高相关的因素包括：随着时间推移患者数量增加、治疗算法、通过电子通信的团队支持以及普通急诊医学（GEM）医生的实时后备支持。减少医疗法律责任也被提及。
通过最少的额外培训和资源，PEP可以提高为有COVID-19症状的APOTM提供紧急护理的舒适度。由于未来的大流行可能对某些患者群体（成人与儿科）产生不成比例的影响，诸如治疗算法、通过电子邮件和短信的团队支持以及专科后备支持等干预措施应纳入紧急护理远程医疗计划的重新部署计划中。未来需要进行研究，以确定其他医学专科在需要时跨专业覆盖不同专科的适应性。
