Rapid creation of an emergency department telehealth program during the COVID-19 pandemic
Samita M. HeslinMichael NappiGerald KellyJoan CrawfordEric J. MorleyVeena LingamMark C. HenryPeter Viccellio
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Abstract:
Coronavirus disease 2019 (COVID-19) has spread to nearly every continent, with over 2.6 m cases confirmed worldwide. Emergency departments care for a significant number of patients who are under investigation for COVID-19 or are COVID-19-positive. When patients present in the emergency department, there is an increased risk of spreading the virus to other patients and staff. We designed an emergency department telehealth program for patients physically in the emergency department, to reduce exposure and conserve personal protective equipment. While traditional telehealth is designed to be patient-specific and device-independent, our emergency department telehealth program was device-specific and patient-independent. In this article, we describe how we rapidly implemented our emergency department telehealth program, used for 880 min of contact time and 523 patient encounters in a 30-day period, which decreased exposure to COVID-19 and conserved personal protective equipment. We share our challenges, successes and recommendations for designing an emergency department telehealth program, building the technological aspects, and deploying telehealth devices in the emergency department environment. Our recommendations can be adopted by other emergency departments to create and run their own emergency department telehealth initiatives.Keywords:
Telehealth
Pandemic
Personal Protective Equipment
Introduction:The COVID-19 pandemic brought unprecedented change to the health care industry, including a large and rapid shift to providing care through telehealth technologies. Although the expansion of telehealth services was successful in continuing to provide patients with care while preventing the spread of disease, it is less clear how patient sociodemographic characteristics influenced telehealth use during this time. This study aims to systematically review the published literature on demographic differences in telehealth access, utilization, and health outcomes among a variety of adult patient types in the United States. Methods:Litcovid, PubMed, Web of Science, and MEDLINE databases were searched, resulting in a final sample of n = 32 studies. Results:Results found that studies could be categorized as addressing at least one of eight different areas of inquiry: sociodemographic differences in telehealth use (1) during and (2) before the pandemic, telehealth use versus nonuse (3) during and (4) before the pandemic, (5) telehealth modality, (6) satisfaction with telehealth, (7) outcomes associated with telehealth use, and (8) perceived or actual access to telehealth services. Discussion:Findings are robust across included studies with respect to racial, age, and socioeconomic differences in telehealth utilization and health outcomes, reflecting sociodemographic differences in health care access, utilization, and outcomes more broadly that persist despite this expansion of telehealth services owing to COVID-19. Additional findings across studies are summarized and areas for future research are discussed.
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In the COVID-19 pandemic, global health care systems have become overwhelmed with potentially infectious patients seeking testing and care. Preventing spread of infection to and from health care workers (HCWs) and patients relies on effective use of personal protective equipment(PPE). The most critical part in due course of managing this pandemic is adequate supply of PPEs. We have customized a PPE which is economical and reusable after proper disinfection. This customized PPE can be a solution to conservation of supply during this pandemic.
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Coronavirus
2019-20 coronavirus outbreak
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This paper reports on the multi-layered research into telehealth in the UK conducted through a critical theory perspective. Telehealth is an umbrella term for health services delivered at a distance and, more specifically, over various telecommunication networks. The paper aims to offer an alternative perspective on telehealth, focusing on rationalities, knowledge claims and ways of legitimising telehealth. The paper concludes that there are competing and difficult to reconcile rationalities influencing telehealth, conflicting knowledge claims and no commonly agreed ways of legitimising telehealth.
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BACKGROUND: While COVID-19 has significantly impacted how healthcare is provided, telehealth services with remote access have dramatically reduced the chance of in-person contact and the costs of services for patients with increased healthcare quality. OBJECTIVE: As the COVID-19 is still a very prevalent part of people’s lives, it is critical to examine what factors affect telehealth, impacts the choice of the prominent and efficient healthcare service platform, and utilizes telehealth effectively and efficiently. METHODS: Grounded on the Self-determination theory (SDT), this research analyzes a sample of 142 response data for the effects of access, need, knowledge, and technology skills, on telehealth utilization mediated by satisfaction via Structural Equation Modeling (SEM). RESULTS: The empirical results indicated that telehealth satisfaction significantly increased the use of telehealth services during the pandemic. Meanwhile, the access, needs, and knowledge of telehealth also significantly increase telehealth utilization directly and indirectly through telehealth satisfaction. Additionally, an individual’s technological skill has no significant effect on telehealth use; instead, it can increase telehealth satisfaction, which increases telehealth utilization. CONCLUSION: The study with its theoretical and practical implications may provide researchers and public health officials with new options and strategies for telehealth services regarding the pandemic issue.
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This chapter examines how telehealth technology might support health care services for aging populations. Telehealth has been defined as the "remote provision of health care services and education by means of information and communications technology". The array of telehealth services includes those normally provided in real time, such as videoconferencing for telemental health therapy, telesurgery, and telerehabilitation. Often, rural populations have disproportionately older compared to younger residents, and telehealth is of special significance to these aging adults. In the case of aging adults, both providers and consumers, careful attention to their abilities will be a necessary condition in both designing and training telehealth use. Telehealth technology holds out the promise of delivering health care services to remote locales without requiring in-person visits by health professionals. A persistent issue for technology systems and telehealth systems is how to design adequate training.
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Telemedicine had a significant increase during the novel coronavirus (COVID-19) pandemic, which is still on course. In different parts of the world, healthcare units had to adapt their practice, and several assistance services were remotely delivered. The present study is a systematic review of studies that had applied telemedicine during the COVID-19 pandemic and had assessed its effects on the delivered care. We have covered a 1-year period in order to assess the initiatives developed during the pandemic time and that had already evaluated the effects of the telemedicine program that had been implemented. All the analyzed studies evidenced a positive effect of telemedicine in the treatment of different conditions, including chronic diseases, mental disorders and oncologic diseases. The real impact of the COVID-19 pandemic in the healthcare sector is still to be fully understood, and telemedicine implementation in different areas is one of its positive legacies.
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With the COVID-19 pandemic, the method for delivering healthcare changed overnight. Telehealth became a primary method of delivering care. Suddenly, nurses were expected to utilize technology with very little, if any, training in telehealth. All evidence suggests that telehealth is here to stay. As such, it is now time for healthcare providers to reflect on best practices for telehealth, and for nurse educators to ensure that graduates are prepared to function in the new telehealth arena. This article provides an introductory overview of the history of telehealth nursing; uses for telehealth with the COVID-19 pandemic; new awareness of telehealth challenges, and nursing roles. We also discuss sites that require a telehealth nurse and the Four P’s framework for telehealth education.
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2019-20 coronavirus outbreak
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Telehealth has been shown to improve access to health care and to reduce costs to the patient and health care system, especially for patients living in rural settings. However, unique challenges arise when implementing telehealth in remote communities.The study aimed to explore the current use, challenges, and opportunities of the Yukon Telehealth System. The lessons learned from this study were used to determine important factors to consider when attempting to advance and expand telehealth programs in remote communities.A mixed methods approach was used to evaluate the Yukon Telehealth System and to determine possible future advances. Quantitative data were obtained through usage logs. Web-based questionnaires were administered to nurses in each of the 14 Yukon community health centers outside of Whitehorse and patients who had used telehealth. Qualitative data included focus groups and semistructured interviews with 36 telehealth stakeholders.Since 2008, there has been a consistent number of telehealth sessions of about 1000 per year, with clinical care as the main use (69.06% [759/1099] of all sessions in 2015). From the questionnaire (11 community nurses and 10 patients) and the interview data, there was a consensus among the clinicians and patients that the system provided timely access and cost savings from reduced travel. However, they believed that it was underutilized, and the equipment was outdated. The following 4 factors were identified, which should be considered when trying to advance and expand a telehealth program: (1) patient and clinician buy-in: past telehealth experiences (eg, negative clinician experiences with outdated technology) should be considered when advancing the system. Expansion of services in orthopedics, dermatology, and psychiatry were found to be particularly feasible and beneficial in Yukon; (2) workflow: the use and scheduling of telehealth should be streamlined and automated as much as possible to reduce dependencies on the single Yukon telehealth coordinator; (3) access to telehealth technology: clinicians and patients should have easy access to up-to-date telehealth technology. The use of consumer products, such as mobile technology, should be leveraged as appropriate; and (4) infrastructure: the required human resources and technology need to be established when expanding and advancing telehealth.While clinicians and patients had generally positive perceptions of the Yukon Telehealth System, there was consensus that it was underutilized. Many opportunities exist to expand the types of telehealth services and the number of telehealth sessions, including the expansion of services in several new specialty areas, updating telehealth equipment to streamline workflows and increase convenience and uptake, and integrating novel technologies. The identified barriers and recommendations from this evaluation can be applied to the development and expansion of telehealth in other remote communities to realize telehealth's potential for providing efficient, safe, convenient, and cost-effective care delivery.
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The covid19 pandemic has made the conditions around the world pathetic, It has made the lives of the people around the world a serious question mark, the disease on the one hand and ultimately making the daily lives of the people miserable. It has given a serious blow to all the industries and job around the world. Due to the pandemic condition and it’s viral spread even the normal people are hesitant to visit the hospitals around them, Therefore this study discusses about the telemedicine and its effectiveness during this pandemic situation making people aware and making hospitals all over to use this telemedicine in treating the patients, how patients can get their clinicians support without visiting the hospitals by using this telemedicine, Finally the study was performed by collecting and analysing relevant secondary data. It has also given suggestions that it is essential to make the people aware about the telemedicine just like making the clinicians aware about the working of the telemedicine.
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2019-20 coronavirus outbreak
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Telehealth technologies promise to increase access to care, particularly in underserved communities. However, little is known about how private payer reimbursements vary between telehealth and non-telehealth services. We use the largest private claims database in the United States provided by the Health Care Cost Institute to identify telehealth claims and compare average reimbursements to non-telehealth claims. We find average reimbursements for telehealth services are significantly lower than those for non-telehealth for seven of the ten most common services. For example, telehealth reimbursements for office visits for evaluation and management of established patients with low complexity were 30% lower than the corresponding non-telehealth service. Reimbursements by clinical diagnosis code also tended to be lower for telehealth than non-telehealth claims. Widespread adoption of telehealth may be hampered by lower reimbursements for telehealth services relative to face-to-face services. This may result in lower incentives for providers to invest in telehealth technologies that do not result in significant cost savings to their practice, even if telehealth improves patient outcomes.
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