JMIR Publications

ABSTRACT

Background:

Older, chronically ill individuals in independent living communities are frequently transferred to the emergency department for acute issues that could be managed in lower acuity settings. Telemedicine is a potential solution.

Objective:

We examined the effectiveness of a telemedicine intervention for emergency triage in an independent living community.

Methods:

In the intervention community, a 950-resident independent senior living community, when a resident called for help, EMT-trained staff could engage an emergency medicine physician via telemedicine to assist with management and triage. To assess intervention impact, we compared trends in emergency department transfers in the intervention community to two communities run by the same company. The primary outcome was the proportion of calls transported to the ED. Secondary outcomes were telemedicine use and post-transport disposition. Semi-structured focus groups of residents and staff were conducted to examine attitudes towards the intervention. Qualitative data analysis used thematic analysis.

Results:

Although the service was offered at no cost to residents, use was low, and we found no evidence of fewer emergency department transfers. The key barrier to program use was resistance from front-line staff members who did not view telemedicine as a valuable tool.

Conclusions:

Staff buy-in is an essential factor in successful telemedicine implementation. First responder readiness to engage in telemedicine interventions has not previously been investigated. How best to engage different front-line providers must be a key consideration in future research investigating telemedicine’s potential for reducing unnecessary emergency transfers in independent living communities.