Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Nov 10, 2022
Date Accepted: May 3, 2023
Hospital-level Implementation Barriers, Facilitators, and Willingness to Use a New Regional Disaster Teleconsultation System: A Survey Study
ABSTRACT
Background:
Teleconsultation with clinical experts can be used in disaster health response, but rapid implementation across state lines is challenging.
Objective:
To guide future implementation, we identified hospital-level barriers, facilitators, and willingness to use a novel regional peer-to-peer disaster teleconsultation system for disaster health response.
Methods:
In 2021, we used the National ED Inventory-USA database to identify all 189 hospital-based and freestanding emergency departments (EDs) in six New England states. We surveyed emergency managers by telephone regarding notification systems used for large-scale no-notice emergency events, access to consultants in six disaster-relevant specialties, disaster credentialing requirements before system use, reliability and redundancy of internet/cellular service, and willingness to use a disaster teleconsultation system (primary outcome). We calculated descriptive statistics and examined hospital/ED disaster response capability by state.
Results:
Overall, 164 (87%) hospitals/EDs responded. Most (90%) receive emergency notification from state-based systems. Forty (24%) hospitals/EDs lacked access to burn specialists, 30 (18%) to toxicologists, 25 (15%) to radiation specialists, and 20 (12%) to trauma specialists. Most (n=115, 70%) would require disaster credentialing of teleconsultants before system use. Of the 113 hospitals/EDs with written disaster credentialing procedures, only 28% could complete them within 24 hours. Most (94%) reported reliable internet/cellular service; 81% of these could maintain cellular service despite internet disruption. Overall, 133 (81%) were somewhat/very likely to use a regional disaster teleconsultation system. Among hospitals/EDs somewhat/very unlikely to use the system (n=26), sufficient access to consultants (69%) and reluctance to use new technology/systems (27%) were common barriers.
Conclusions:
Most New England hospitals/EDs have access to state emergency notification systems, telecommunication infrastructure, and willingness to use a new regional disaster teleconsultation system. Policies/procedures to speed disaster credentialing are needed.
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