JMIR Publications

ABSTRACT

Background:

Early efforts to incorporate telemedicine in the Emergency Department (ED) focused on providing remote consultation services to EDs with limited resources. With continued ED overcrowding, some EDs have used telemedicine to increase providers during surges of patient visits and offer scheduled “home” face to face on-screen visits. We used remote on-screen telemedicine providers in the “screening-in-triage” role during hours in which our ED did not previously have in-person screening.

Objective:

Compare efficiency and patient safety of in-person screening vs telescreening

Methods:

This is a retrospective, matched cohort study to compare the performance of real-time remote telescreening to in-person screening at a single urban academic ED. 337 screening hours were compared to 315 equivalent proximate hours of telescreening. Participants were selected from an ED convenience sample. Using electronic medical records we compared patients screened per hour, rates of patients leaving without being seen (LWBS), rates of analgesia ordered and proportion of patients with chest pain being ordered a standard set of tests and medications.

Results:

Over the 22 weeks of our study in-person screeners evaluated 1933 participants over 337 hours, 5.7 patients-per-hour, while telescreeners saw 1497 patients over 315 hours, 4.9 patients per hour, (p<0.001). However, for the final three weeks of the evaluation, the rates were not statistically different (5.5 v 5.3) (p=0.66). Fewer patients LWBS during in-person screening compared to telescreening hours, (2.6 vs. 3.8%; p=0.03). Yet, when compared to prior year date and time-matched data, implementation of telescreening from 1-3am, a time when in-person screening was not used, decreased the rate of LWBS from 25.1% to 4.5%, p<0.001. Analgesia was ordered more frequently by telescreeners, 51 vs 32%, p<0.001. Screeners ordered a full chest pain bundle for those presenting with chest pain and triaged to an ESI level 3-5 34% of the time compared to telescreeners ordering 37%, p=0.18.

Conclusions:

While the rate of patients seen per hour during telescreening was lower throughout the course of our study, this effect was driven by early differences and by the last three weeks the rates of patients screened was not statistically different between in-person and telescreening. Significantly, adding telescreening during 1-3am on weekdays, a time when screening did not previously occur, we were able to decrease the rates of LWBS from 25.1% to 4.5%. More analgesia was ordered by telescreeners but this is driven by established practice patterns of the telescreening providers. No difference was observed for rates of ordering a standard set of labs, imaging and medications for those screened with a chief complaint of chest pain. Telescreening was an effective and safe way for this ED to expand the hours in which patients were screened by a health care provider in triage.