Cutting exposure to COVID-19 in EDs using on-site telehealth

Telehealth has been gaining ground as a breakout star of the COVID-19 pandemic. But while much of the recent attention has focused on using it to treat patients at home, the practice has also been vital to keeping clinical staff members safer as providers revamp emergency departments to curb the risk of infection.

Telehealth played a major role when Renown Health set up a medical tent during the early days of the pandemic to expand its ED’s triage capacity for patients with COVID-19 symptoms.

After getting their vital signs taken by a nurse in-person, patients would speak with an emergency medicine physician via video, who would determine whether they needed testing, treatment or another next step.

The Reno, Nev.-based system took down its alternate care site in June, but has kept aspects of that virtual component alive in its ED. “Our first priority is patient safety and patient care,” said Dr. Paul Sierzenski, an emergency medicine physician and chief medical officer for acute-care services at Renown. “Right next to that is our staff safety and staff care.”

When patients present at the ED, they’re immediately screened for COVID-19. Those with symptoms are sent to an individual room, where they’ll typically use a tablet or telehealth cart—which includes internet-connected devices, such as digital stethoscopes—to complete a virtual evaluation and assessment with a physician, depending on their acuity.

Renown uses software and hardware from a few different companies for its telehealth program.

It’s the first time the health system has used telehealth to connect its on-site physicians to ED patients, though it has provided telehealth consultations for specialty services like stroke care and behavioral health to EDs for years.

Some health systems were adding telehealth to their EDs before COVID-19 hit. Those with high ED visit volumes in particular had been rolling out processes for physician assistants or physicians—often based at a central station, but managing patients at multiple facilities—to help triage patients via telehealth, in an effort to reduce long wait times, said Arielle Trzcinski, a senior analyst at market research firm Forrester.

That type of “tele-triage” can help a facility manage capacity, since a remote physician assistant or physician can redirect patients who might be a better fit for urgent or primary care. For patients with more pressing cases, staff can start ordering lab tests and X-rays before a patient even gets to an exam room. 

It’s become more common to see telehealth in EDs since March, as health systems have wanted to address patient surges quickly and use portable video equipment in new ways to decrease clinicians’ COVID-19 exposure, Trzcinski said. She believes many health systems will keep the new processes in place, at least for busy times of the year, such as flu season.

Emergency medicine staff at Aurora St. Luke’s Medical Center, a Milwaukee hospital that’s part of Advocate Aurora Health, had been thinking about using remote physician assistants to help triage patients, but the practice didn’t catch on until COVID cases started mounting. Since the spring, patients who present at Aurora St. Luke’s ED with COVID-19 symptoms are directed to a so-called “hot zone”; those without symptoms are sent to the “cold zone.” A telehealth cart with a tablet is rolled over, so a physician assistant—located elsewhere in the hospital—can remotely triage patients in both areas.

The tele-triage system lets remote physician assistants assess any patient without having to change personal protective equipment, said Dr. Bill Lieber, an emergency medicine physician who has practiced at the hospital for more than 15 years.

The tele-triage system is likely to remain at Aurora St. Luke’s after the pandemic subsides, Lieber said. Aurora St. Luke’s uses virtual care technology from EmOpti for tele-triage.

Aside from reducing risk of exposure, Lieber said it has helped with efficiency, since the physician assistant can remotely triage patients at other facilities while at Aurora St. Luke’s.

EmOpti bases its software fees on a facility’s annual ED visit volumes, according to Dr. Edward Barthell, an emergency medicine physician and the company’s founder and CEO.

It’s too early to share outcomes from Aurora St. Luke’s tele-triage use, but a sister hospital saw its typical patient wait time drop from 40 minutes to 10 minutes after implementing tele-triage, according to Barthell. The hospital’s length of stay for patients discharged from the ED decreased by 45 minutes.


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