key: cord-0778196-9mgdqvpb
authors: Lyon, M.; Kuchinski, A.; Coule, P.; Gibson, R.
title: 52 Acceptance of Telemedicine Screening for COVID-19 Outside Usual Health System Catchment Area
date: 2020-10-31
journal: Annals of Emergency Medicine
DOI: 10.1016/j.annemergmed.2020.09.062
sha: 46827d366d446d0c135c959a819ad8923a152f7a
doc_id: 778196
cord_uid: 9mgdqvpb

nan

Conclusion: Air EMS significantly decreases risk of mortality when compared to ground EMS. The likelihood to transfer to a higher acuity care hospital is similar if the trauma cases are transferred by air or ground EMS.

Vinton D, Thomson N/University of Virginia, Charlottesville, VA Study Objectives: Remote in-home monitoring technology has become an increasingly important means to conserve hospital and emergency department (ED) capacity while providing observation and care for high-risk patients with milder symptoms during the COVID-19 pandemic. We aimed to evaluate the safety of introducing an Interactive Home Monitoring program (IHM) for high-risk patients discharged from the emergency department (ED) with suspected or confirmed COVID-19 who without remote monitoring would have required admission to the hospital.

Methods: We assessed the clinical outcome of ED patients with suspected or confirmed COVID-19 who had a risk factors for severe disease and were discharged from the ED with IHM. Patients were identified for enrollment in the IHM program if they had suspected or confirmed COVID-19 and had risk factors for severe illness from COVID-19 as defined by the Centers for Disease Control and Prevention (CDC) guidelines. Eligible ED patients were required to be hemodynamically stable with no new oxygen requirement, but assessed by an ED attending physician as needing hospital admission. Patients who met criteria were enrolled in the IHM program prior to ED discharge and were provided with equipment including a blood pressure cuff, pulse oximeter, thermometer, iPad, instructions on how to use the equipment, and 24 hour technical assistance hotline. At home patients were remotely managed by trained Advanced Practitioner Providers who addressed vital sign changes and escalated care needs when appropriate. The clinical course of IHM patients including return ED visits, hospital admissions, and hospital course were followed for 30 days following ED discharge.

Results: A total of 52 ED patients were enrolled in the IHM program from 4/15/ 20 to 5/30/20. 7 patients required a return visit to the ED (13%; 95% CI) with 6 patients requiring admission to the hospital (12%, CI 95%). All 6 admitted patients (100%) were admitted a floor bed with a mean length-of-stay of 3.3 days (s ¼ 1.7 days). The most common reason for admission was hypoxia (50%) or dehydration (50%). No IHM patient required intubation, non-invasive positive pressure ventilation, or respiratory support beyond 2-4 liters of supplemental oxygen. The one patient who presented to the ED but did not require admission was diagnosed with non-COVID related chest pain. No mortalities occurred during the study period nor were there any documented adverse outcomes noted for patients discharged home on IHM.

Conclusion: In this initial review to assess the safety of introducing IHM for highrisk ED patients with confirmed or suspected COVID, we found that patients without a new oxygen requirement and stable vital signs could be discharged home with remote monitoring without increasing the risk for adverse clinical outcomes. Additionally, the introduction of the IHM program reduced hospital admissions for this patient population, decreased potential hospital exposures, and conserved critical inpatient beds for unstable patients requiring onsite medical care.

Lyon M, Kuchinski A, Coule P, Gibson R/Medical College of Georgia at Augusta University, Augusta, GA Study Objectives: In order to prevent spread of an infectious disease such as COVID-19 widespread testing is needed. However, few communities, particularly in states with large rural and medically underserved populations, have the infrastructure or expertise to start such a testing program especially within a short period of time. Further a standardized approach to screening for the appropriateness of COVID-19 testing is critical to not overwhelming hospital and state resources. Telemedicine offers a method which can standardize screening without limitations of catchment area, county and state borders. Our objective was to evaluate the utilization of a telemedicine screening program by patients outside the usual catchment area of a health care system.

Methods: This was a prospective observational study measuring the outcomes of a telemedicine based COVID-19 screening program. The telemedicine health system consists of a single tertiary care hospital on the border of 2 states. The telemedicine screening program was free to the citizens of Georgia and South Carolina. Demographic and location data was collected in the telemedicine app utilized for the telemedicine contacts. Usual catchment area of the telemedicine health system is defined from population health data using patient county of residence.

Results: From March 13, 2020 until June 10, 2020, 24,510 telemedicine visits have been completed with 20,165 (82%) from Georgia and 4345 (18%) from South Carolina. 2649 (10.4%) were less than 20 years of age, 3577 (14.6%) were older than 60 years of age and 211 (0.8%) were older than 80 years of age. 15,280 (62%) were male and 9,355 (38%) female. 15,550 (63.4%) of the telemedicine visits were from citizens of the surrounding 4 counties (catchment area) with the remainder (8,960) spread across Georgia and South Carolina. 15,441 (63%) were sent for COVID-19 testing. Correlation of telemedicine visit from rural counties will be added.

Conclusion: The rapid development and deployment of a statewide COVID-19 screening program is feasible. Citizens will utilize a telemedicine platform outside their home geographic area for screening services unavailable locally. Geographic borders and traditional hospital catchment areas are less significant when utilizing telemedicine allowing for health care to be delivered to rural and health care-poor communities.

Innovative strategies were needed for PPE conservation. Our ED deployed electronic PPE (ePPE) -a telehealth approach to conduct medical screening exams (MSEs) of COVID-19-suspected patients. As part of our plan to scale this intervention, we sought to evaluate provider perceptions of ePPE-based MSEs. Methods: We conducted a qualitative analysis at Vanderbilt University Medical Center

A Likert scale between 1 [Not at all effective] and 5 [Extremely effective] was used to gauge perceived ePPE effectiveness. We recorded and transcribed interviews, subsequently extracting then encoding notable excerpts using Dedoose