Preliminary Assessment of a Telehealth Approach to Evaluating, Treating, and Discharging Low Acuity Patients with Suspected COVID-19

Abstract:

Background

Telemedicine is uniquely positioned to address challenges posed to emergency departments (EDs) by the COVID-19 pandemic. By reducing in-person contact, it should decrease provider risk of infection and preserve personal protective equipment (PPE).

Objectives

To describe and assess the early results of a novel telehealth workflow in which remote providers collaborate with in-person nursing to evaluate and discharge well-appearing, low-risk ED patients with suspected COVID-19 infection.

Methods

Retrospective chart review was completed three weeks after implementation. Metrics include the number of patients evaluated, number of patients discharged without in-person contact, telehealth wait time and duration, collection of testing, ED length of stay (ED-LOS), 72-hour return, number of in-person healthcare provider contacts, and associated PPE use.

Results

Among 302 patients evaluated by telehealth, 153 patients were evaluated and discharged by a telehealth provider with reductions in ED-LOS, PPE use, and close contact with healthcare personnel. These patients had a 62.5% shorter ED-LOS compared to other ESI Level 4 patients seen over the same time period. Telehealth use for these 153 patients saved 413 sets of PPE. We observed a 3.9% 72-hour revisit rate. One patient discharged after telehealth evaluation was hospitalized on a return visit 9 days later.

Conclusion

Telehealth can be safely and efficiently used to evaluate, treat, test, and discharge ED patients suspected to have COVID-19. This workflow reduces infection risks to healthcare providers, PPE use, and ED-LOS. Additionally, it allows quarantined but otherwise well clinicians to continue working.

Article Summary:

Why is this topic important?

● Telemedicine is uniquely positioned to address many of the challenges posed to emergency departments (EDs) by the COVID-19 pandemic. Using telehealth to evaluate and potentially discharge low-risk, well-appearing patients with suspected COVID-19 infection should decrease infection risk to providers, preserve personal protective equipment (PPE), and potentially mitigate surge.

What does this study attempt to show?

● This study describes and assesses the preliminary results of a novel telehealth workflow in which remote providers collaborate with in-person nursing to evaluate and discharge well-appearing, low-risk ED patients with suspected COVID-19 infection.

What are the key findings?

● One hundred fifty-three patients were evaluated and discharged by a telehealth provider, with reductions in length of stay, PPE use, and close contact with healthcare personnel. The practice appears safe, with a 3.9% 72-hour revisit rate.

How is patient care impacted?

● Patients discharged by a telehealth provider had a 62.5% shorter length of stay compared to other ESI Level 4 patients seen over the same time period. Using telehealth to discharge these well-appearing patients can help unload a busy ED, mitigating surge. Reducing PPE usage and decreasing provider infection risk supports a sustained ED response to the continuing pandemic.