Department of Emergency Medicine, Naval Medical Center Portsmouth, Portsmouth, VA; Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
Department of Emergency Medicine, Naval Medical Center Portsmouth, Portsmouth, VA.
J Emerg Med. 2022 Dec;63(6):747-754. doi: 10.1016/j.jemermed.2022.09.014. Epub 2022 Sep 12.
Coronavirus disease 2019 (COVID-19) placed additional strain on an already struggling health care system. In response, novel solutions such as telehealth have been explored, however, there is significant room for innovation in health care delivery.
The aim of our study was to evaluate the effectiveness of a drive-through medical treatment system for evaluating patients with COVID-like symptoms.
We designed a prototype drive-through medical treatment facility (DMF) to triage large volumes of patients quickly and efficiently, while fully evaluating, treating, and discharging low-risk patients. A retrospective chart review was performed to extract clinical and logistical metrics.
A total of 2164 patients were evaluated between May 1 and July 1, 2020. Overall accuracy for patient classification was 92.4% (95% confidence interval [CI] 91.2-93.5%). Screening criteria resulted in a return with need for workup or admission rate of 0.25%, yielding a sensitivity of 83.3% (95% CI 65.3-94.4%). Of those presenting to the DMF, 179 patients (8.3%) were diverted to the main emergency department (ED) for further evaluation, of which 14% received diagnostic workups and 5% subsequent admission to an inpatient service, yielding a specificity of 92.8% (95% CI 91.7- 93.9%). Length of stays for those seen in the DMF vs. the main ED (M = 38 min vs 149 min) yielded a mean difference of 111 min per encounter and a total time savings of 3762 h.
Drive-through medical systems can accurately triage patients presenting with potential COVID-19 and effectively treat lower-risk patients, thereby reducing ED utilization.
2019 年冠状病毒病（COVID-19）给本已陷入困境的医疗体系带来了更大的压力。作为回应，人们探索了远程医疗等新方法，但医疗服务的创新仍有很大空间。
我们的研究旨在评估用于评估具有 COVID 样症状患者的驾驶式医疗治疗系统的有效性。
我们设计了一个驾驶式医疗治疗设施（DMF）原型，以快速有效地对大量患者进行分诊，同时对低风险患者进行全面评估、治疗和出院。进行了回顾性图表审查以提取临床和后勤指标。
2020 年 5 月 1 日至 7 月 1 日期间，共有 2164 名患者接受了评估。患者分类的总体准确率为 92.4%（95%置信区间 [CI] 91.2-93.5%）。筛查标准导致需要复查或入院的患者比例为 0.25%，敏感性为 83.3%（95%CI 65.3-94.4%）。在前往 DMF 的患者中，179 名患者（8.3%）被转至主急诊部（ED）进行进一步评估，其中 14%接受了诊断性检查，5%随后被收入住院服务，特异性为 92.8%（95%CI 91.7-93.9%）。在 DMF 就诊的患者与在主 ED 就诊的患者的停留时间（M=38 分钟与 149 分钟）之间的平均差异为 111 分钟/次，总节省时间为 3762 小时。
驾驶式医疗系统可以准确地对具有潜在 COVID-19 风险的患者进行分诊，并有效地治疗低风险患者，从而减少 ED 的使用。
