Source avec lien : The Journal of Emergency Medicine, (Prépublication), 8/7/2020. 10.1016/j.jemermed.2020.08.007
Contexte La télémédecine est particulièrement bien placée pour relever les défis posés aux services d’urgence par la pandémie de COVID-19. En réduisant les contacts en personne, elle devrait diminuer le risque d’infection des prestataires et préserver les équipements de protection individuelle (EPI). Objectifs Décrire et évaluer les premiers résultats d’un nouveau processus de télésanté dans lequel des prestataires de soins à distance collaborent avec des infirmières en personne pour évaluer et libérer des patients à faible risque qui semblent bien portants et qui présentent une suspicion d’infection par COVID-19.
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.