Telemedicine Evaluations for Low-Acuity Patients Presenting to the Emergency Department: Implications for Safety and Patient Satisfaction.

Background:Telemedicine is being rapidly adopted by traditional health care systems. We have used telemedicine in a program we call Express Care to allow a single physician to remotely perform evaluations of low-acuity patients.Materials and Methods:We conducted a retrospective cohort study of quality assurance data comparing low-acuity patients treated by an emergency department (ED) physician through telemedicine (Express Care) with those treated by an ED physician in person between July 16, 2016 and September 30, 2017. We compared patient demographics, length of stay (LOS), visit severity as measured by emergency severity index (ESI), visit diagnosis type, return visits, and patient satisfaction scores.Results:There were 3,266 low-acuity patients seen through telemedicine and 21,129 seen in person during the observation period. Patients receiving evaluation by telemedicine were younger (mean age ± standard deviation [in years]: 42 ± 18 vs. 45 ± 17; p < 0.001) and more likely to be male (51% vs. 46%; p < 0.001). Median ESI was slightly lower for patients treated by telemedicine [4 (4-5) vs. 4 (4-4); p < 0.001], and there were modest differences in diagnosis type between the two groups. Median ED LOS was 63.6 (interquartile range [IQR] 42.6-93.6) min for telemedicine patients and 133.8 (IQR 90.6-196.8) min for patients seen in person (p < 0.001). Seventy-two hour returns (3.4% vs. 3.0%; p = 0.302) and 72-h returns requiring admission (0.2% vs. 0.3%; p = 0.252) were similar between groups. Patient satisfaction scores were also similar between the groups.Conclusion:Telemedicine evaluation for ED patients can be effective and safe when treating low-acuity conditions without compromising patient satisfaction.

A telehealth program to perform medical screening examinations.

The importance of a timely medical screening examination on ED throughput, efficiency, and patient safety cannot be underestimated. This article describes a telemedicine program based on the provider in triage model that uses physician assistants and NPs to improve patient door-to-diagnostic evaluation times in the ED.

Measuring the effect of a competency-based education conference for PAs and NPs.

OBJECTIVE: To evaluate the effectiveness of a competency-based continuing medical education (CME) conference model for physician assistants (PAs) and NPs. METHODS: This mixed-method research included a pretest/post-test assessment of knowledge and procedural assessment for six clinical skills, along with an open-ended survey to assess the value of an educational conference for PAs and NPs (N = 48) in an urban academic healthcare facility. RESULTS: Significant increases in knowledge scores and all six clinical skill procedures were noted from pre- to post-test. Participants said they acquired new techniques and knowledge (55%) or improved current knowledge and skills (40%). CONCLUSIONS: The competency-based conference model could serve as a viable method for providing evidence-based learning and informed practice as well as instilling reflective practice and a commitment to personal growth.

Clinical informatics during the COVID-19 pandemic: Lessons learned and implications for emergency department and inpatient operations.

In response to a pandemic, hospital leaders can use clinical informatics to aid clinical decision making, virtualizing medical care, coordinating communication, and defining workflow and compliance. Clinical informatics procedures need to be implemented nimbly, with governance measures in place to properly oversee and guide novel patient care pathways, diagnostic and treatment workflows, and provider education and communication. The authors' experience recommends (1) creating flexible order sets that adapt to evolving guidelines that meet needs across specialties, (2) enhancing and supporting inherent telemedicine capability, (3) electronically enabling novel workflows quickly and suspending noncritical administrative or billing functions in the electronic health record, and (4) using communication platforms based on tiered urgency that do not compromise security and privacy.