A Telemedicine Approach to Covid-19 Assessment and Triage

Use of a Kiosk-Model Self-Triage System for COVID-19 Triage

Purpose

Pandemics put healthcare workers (HCWs) at risk of infections, making emergency department (ED) triage critical. This study aims to compare smart innovative self-kiosk triage (SKT) with routine triage (RT).

Patients and Methods

COVID-19-suspected ED patients enrolled. Volunteers received RT after completing SKT. The key outcomes were HCW exposure and total exposure time (TET). Secondary outcomes included participants' satisfaction with SKT.

Results

The study included 115 patients with a mean age of 32.54±10.84 years old. SKT significantly reduced HCW exposures (median 0 [IQR 0-1] vs 2 [IQR 2-3], p<0.0001) and triage time (median 3 [IQR 2-3] vs 8 [IQR 5-10] minutes, p<0.0001), compared to RT. Elevated body temperature increased RT time (p=0.003), while higher education levels reduced SKT time (p=0.019). Oxygen saturation influenced HCW exposure in both methods, with higher saturation decreasing HCW exposure during RT (p=0.008) and increasing it during SKT (p=0.017). A PCR-positive status was associated with increased RT time but fewer HCW exposures. 80.0% of participants completed SKT independently. The majority of participants (72.8-82.9%) agreed or strongly agreed, based on a 4-point Likert scale, that the SKT procedure was user-friendly (mean score: 3.40±1.08), with clear instructions (3.35±1.16), easy-to-use oximetry and thermometer (3.12±1.29 and 3.31±1.16, respectively), and a reasonable time requirement (3.37±1.23).

Conclusion

Our findings suggest that emergency department self-kiosk triage can minimize medical staff exposure and time spent with COVID-19-risk patients, without compromising patient satisfaction.

Telemedicine Utilization in Tertiary, Specialized, and Secondary Hospitals in Thailand

Introduction

COVID-19 has accelerated the adoption of telemedicine for counseling, follow-up examination, and treatment purposes. The official guidelines in Thailand were launched to regulate or frame the protocols for health care professions and teams in different organizations.

Objectives

To explore the trend of telemedicine utilization in selected hospitals in Thailand and to understand the characteristics of patients who used telemedicine from 2020 to 2023.

Methods

This retrospective secondary data analysis was conducted in four hospitals in Thailand: two tertiary care (T1 and T2) hospitals, one secondary care (SN) hospital, and one specialized (SP) hospital. Data were routinely collected when services were provided and were categorized into telemedicine outpatient department (OPD) visits or onsite OPD visits. The data included demographic information (age, sex), date and year of service, location (province and health region), and primary diagnosis (using International Statistical Classification of Diseases and Related Health Problems 10th Revision codes). Descriptive analysis was conducted using R and STATA software.

Results

All four hospitals reported an increase in telemedicine use from 2020 to 2023. The majority of telemedicine users were female (>65%) at all hospitals except for the SP hospital (44%). Participants aged 25-59 years reported greater utilization of telemedicine than did the other age-groups. The within-hospital comparison between OPD visits before and after telemedicine was significant (p < 0.001).

Conclusion

The situation during the COVID-19 pandemic and the transition to the post-COVID-19 era impacted telemedicine utilization, which could support national monitoring and evaluation policies. However, further studies are needed to explore other aspects, including changes in telemedicine utilization over time for longer timeframes, effectiveness of telemedicine, and consumer satisfaction.

Evaluation of a virtual ward model of care and readmission characteristics during the COVID-19 pandemic within an Australian tertiary hospital

BACKGROUND

Virtual ward (VW) models of care established during the coronavirus disease 2019 (COVID-19) pandemic provided safe and equitable provision of ambulatory care for low-risk patients; however, little is known about patients who require escalation of care to hospitals from VWs.

AIM

To assess our VW model of care and describe the characteristics of patients admitted to the hospital from the VW.

METHODS

Observational study of all patients admitted to a tertiary hospital COVID-19 VW between 1 December 2021 and 30 June 2022. Utilisation and epidemiological characteristics were assessed for all patients while additional demographics, assessments, treatments and outcomes were assessed for patients admitted to the hospital from the VW.

RESULTS

Of 9494 patient admissions, 269 (2.83%) patients identified as Aboriginal and Torres Strait Islander and 1774 (18.69%) were unvaccinated. The median length of stay was 5.10 days and the mean Index of Relative Socio-economic Advantage and Disadvantage decile was 5.73. One hundred sixty (1.69%) patients were admitted to the hospital from the VW, of which 25 were adults admitted to medical wards. Of this cohort, prominent comorbidities were obesity, hypertension, asthma and frailty, while the main symptoms on admission to the VW were cough, fatigue, nausea and sore throat. High Pandemic Respiratory Infection Emergency System Triage (PRIEST), Veterans Health Administration COVID-19 (VACO), COVID Home Safely Now (CHOSEN) and 4C mortality scores existed for those readmitted.

CONCLUSIONS

This VW model of care was both safe and effective when applied to a broad socioeconomic population during the COVID-19 pandemic. While readmission to the hospital was low, this study identified key characteristics of such presentations, which may assist future triaging, escalation and resource allocation within VWs during the COVID-19 pandemic and beyond.

Implementation of a Triage Protocol Outside the Hospital Setting for Timely Referral During the COVID-19 Second Wave in Chennai, India

India experienced a surge in COVID-19 cases during the second wave in the period of April-June 2021. A rapid rise in cases posed challenges to triaging patients in hospital settings. Chennai, the fourth largest metropolitan city in India with an 8 million population, reported 7564 COVID-19 cases on May 12, 2021, nearly 3 times higher than the number of cases in the peak of COVID-19 in 2020. A sudden surge of cases overwhelmed the health system. We had established standalone triage centers outside the hospitals in the first wave, which catered to up to 2500 patients per day. In addition, we implemented a home-based triage protocol from May 26, 2021, to evaluate patients with COVID-19 who were aged ≤45 years without comorbidities. Among the 27,816 reported cases between May 26 and June 24, 2021, a total of 16,022 (57.6%) were aged ≤45 years without comorbidities. The field teams triaged 15,334 (55.1%), and 10,917 (39.2%) patients were evaluated at triage centers. Among 27,816 cases, 19,219 (69.1%) were advised to self-isolate at home, 3290 (11.8%) were admitted to COVID-19 care centers, and 1714 (6.2%) were admitted to hospitals. Only 3513 (12.7%) patients opted for the facility of their choice. We implemented a scalable triage strategy covering nearly 90% of the patients in a large metropolitan city during the COVID-19 surge. The process enabled early referral of high-risk patients and ensured evidence-informed treatment. We believe that the out-of-hospital triage strategy can be rapidly implemented in low-resource settings.

The theory behind and factors influencing the use of telemedicine during the COVID-19 pandemic: A systematic review

A paradigm change in patient health care toward telemedicine services was necessary in 2020 due to the COVID-19 pandemic, which broke out at the end of 2019. Theories used in determining the determinants of telemedicine utilization are various theories. Research conducted on the use of telemedicine still has doubts about the basic theory used in analyzing the factors that influence telemedicine, especially during the Covid-19 pandemic. The goal of this study is to outline the fundamental principles of telemedicine utilization during the Covid-19 outbreak and the variables that affect it. This Literature Review uses the scoping review method with the tool procedure, namely PRISMA. Based on the conducted literature review, there are 12 scholarly papers addressing the variables that affect the utilization of telemedicine services. During the Covid 19 epidemic, more individuals in many nations used telemedicine services. Anderson's theory of health care use and the idea of technology adoption or acceptance serve as the foundational theories for forecasting the variables that affect the use of telemedicine. The utilization of telemedicine is influenced by 29 different factors that come from different theories. The desire for health, exposure to COVID 19, co-morbidities, social media usage, avoiding contamination, time efficiency, ease of use of services, social impact, and hedonic incentive are among the factors associated to the COVID 19 pandemic.

The Quality of Telenursing-Israeli Nursing Staff's Perceptions

BACKGROUND

The outbreak of the COVID-19 pandemic has increased telemedicine and telenursing services worldwide, developed this innovative treatment's potential, and emphasized its importance. The constraints imposed by the pandemic breached regulatory, psychological, and organizational obstructions among both patients and caretakers. Community and hospital nursing services were forced to deal with a new reality, to provide remote care solutions for bedridden chronic patients, as the need for this grew exponentially. Despite the increase of telemedicine in recent years, so far no research in Israel has investigated the nursing staff's perceptions of the quality of the care provided through telenursing.

OBJECTIVE

To assess nurses' perceptions of the quality of the care provided through telenursing compared to face-to-face nursing.

METHOD

A quantitative cross-sectional study among 227 male and female nurses in Israel. The questionnaire included demographic questions, and the five measures of quality of care: concern and empathy for the patient, professional treatment, response to treatment, educated use of resources, and patients' sense of security.

RESULTS

Significant differences were found between nurses' perceptions of telenursing and face-to-face nursing. The quality of face-to-face nursing was perceived as more positive than that of telenursing, in general, as were the individual measures of care quality such as providing professional treatment, response to treatment, and patients' sense of security.

CONCLUSIONS

Although telemedicine has increased significantly in recent years, nursing staff still perceived the quality of care and follow-up of face-to-face nursing as more positive. It is important to continue to monitor nurses' perceptions and attitudes towards the strengths of these two treatment methods, not only in crisis situations, but among wider populations, and to investigate the factors that could influence these perceptions.

The Role of Telemedicine in Prehospital Traumatic Hand Injury Evaluation

Unnecessary ED visits and transfers to hand clinics raise treatment costs and patient burden at trauma centers. In the present COVID-19 pandemic, needless transfers can increase patients' risk of viral exposure. Therefore, this review analyzes different aspects of the remote diagnosis and triage of traumatic hand injuries. The most common file was photography, with the most common devices being cell phone cameras. Treatment, triage, diagnosis, cost, and time outcomes were assessed, showing concordance between teleconsultation and face-to-face patient evaluations. We conclude that photography and video consultations are feasible surrogates for ED visits in patients with traumatic hand injuries. These technologies should be leveraged to decrease treatment costs and potentially decrease the time to definitive treatment after initial evaluation.

Virtual Care Access and Health Equity during the COVID-19 Pandemic, a qualitative study of patients with chronic diseases from Canada

OBJECTIVES

The COVID-19 pandemic has led to the widespread uptake of virtual care in Canada; however, virtual care may also create new barriers to health care. The purpose of this paper was to explore patient perceptions and concerns around virtual care access.

METHODS

Between February and April 2020, we conducted semi-structured interviews with participants from four chronic disease clinics (stroke, epilepsy, amyotrophic lateral sclerosis, obstetrics medicine) in a mid-sized academic hospital in Southern Ontario, Canada. Consecutive sampling was done by including the patients receiving virtual care in those months. Caregivers were invited to participate in the event that patients were unable to participate in the interview. Thematic analysis was employed to identify overarching themes, and codes were reviewed and refined using a consensus process.

RESULTS

We interviewed 31 participants (27 patients, four caregivers) that had taken part in virtual care. Our findings suggested that the COVID-19 pandemic served to isolate participants and had negatively impacted their access to health care. However, virtual care did provide a safe avenue for patients to receive care and served as a reassuring option during the pandemic. Low technological literacy and access were identified as barriers to virtual care. Greater awareness and patient engagement is needed in future research to improve access.

CONCLUSION

Certain populations can be disproportionately affected by differential access to virtual care. Future studies should examine how social determinants intersect to impact virtual health care access in different patient populations.

Cardiovascular Disease Complicating COVID-19 in the Elderly

SARS-CoV-2, a single-stranded RNA coronavirus, causes an illness known as coronavirus disease 2019 (COVID-19). The highly transmissible virus gains entry into human cells primarily by the binding of its spike protein to the angiotensin-converting enzyme 2 receptor, which is expressed not only in lung tissue but also in cardiac myocytes and the vascular endothelium. Cardiovascular complications are frequent in patients with COVID-19 and may be a result of viral-associated systemic and cardiac inflammation or may arise from a virus-induced hypercoagulable state. This prothrombotic state is marked by endothelial dysfunction and platelet activation in both macrovasculature and microvasculature. In patients with subclinical atherosclerosis, COVID-19 may incite atherosclerotic plaque disruption and coronary thrombosis. Hypertension and obesity are common comorbidities in COVID-19 patients that may significantly raise the risk of mortality. Sedentary behaviors, poor diet, and increased use of tobacco and alcohol, associated with prolonged stay-at-home restrictions, may promote thrombosis, while depressed mood due to social isolation can exacerbate poor self-care. Telehealth interventions via smartphone applications and other technologies that document nutrition and offer exercise programs and social connections can be used to mitigate some of the potential damage to heart health.

Mapping the Role of Digital Health Technologies in Prevention and Control of COVID-19 Pandemic: Review of the Literature

BACKGROUND

Coronavirus Disease (COVID-19) is currently spreading exponentially around the globe. Various digital health technologies are currently being used as weapons in the fight against the pandemic in different ways by countries. The main objective of this review is to explore the role of digital health technologies in the fight against the COVID-19 pandemic and address the gaps in the use of these technologies for tackling the pandemic.

METHODS

We conducted a scoping review guided by the Joanna Briggs Institute guidelines. The articles were searched using electronic databases including MEDLINE (PubMed), Cochrane Library, and Hinari. In addition, Google and Google scholar were searched. Studies that focused on the application of digital health technologies on COVID-19 prevention and control were included in the review. We characterized the distribution of technological applications based on geographical locations, approaches to apply digital health technologies and main findings. The study findings from the existing literature were presented using thematic content analysis.

RESULTS

A total of 2,601 potentially relevant studies were generated from the initial search and 22 studies were included in the final review. The review found that telemedicine was used most frequently, followed by electronic health records and other digital technologies such as artificial intelligence, big data, and the internet of things (IoT). Digital health technologies were used in multiple ways in response to the COVID-19 pandemic, including screening and management of patients, methods to minimize exposure, modelling of disease spread, and supporting overworked providers.

CONCLUSION

Digital health technologies like telehealth, mHealth, electronic medical records, artificial intelligence, the internet of things, and big data/internet were used in different ways for the prevention and control of the COVID-19 pandemic in different settings using multiple approaches. For more effective deployment of digital health tools in times of pandemics, development of a guiding policy and standard on the development, deployment, and use of digital health tools in response to a pandemic is recommended.

Systematic review on telemedicine platforms in lockdown periods: Lessons learned from the COVID-19 pandemic

With the onset of the coronavirus disease 2019 (COVID-19) outbreak, the transformation of the care delivery model from conventional in-person (face to face) to largely virtual or remote care has been accelerated to appropriately allocate resources and constrain the spread of the virus. In this regard, telemedicine is a breakthrough technology to battle against the COVID-19 emergency. Therefore, we sought to identify the telemedicine applications in the COVID-19 pandemic (tele-COVID) according to interaction modes, transmission modalities, and disease categories. This systematic review was conducted through searching five databases including PubMed, Scopus, ProQuest, Web of Science, and Science Direct. Inclusion criteria were studies clearly outlining any use of telemedicine interactive mode during the COVID-19 pandemic, written in English language and published in peer-reviewed journals in 2020. Finally, 43 articles met the inclusion out of the 1118 search results. Telemedicine provides a diversity of interaction modes and modalities affordable by patients and physicians including short message service, E-mail and web portals, secure telephone calls or VOIP, video calls, interactive mobile health applications (m-Health), remote patient monitoring, and video conferencing. Transmission of video data using synchronized video calls via common social media had the highest and exchange of data using store-forward service via secure messaging technology and prerecorded multimedia had the lowest popularity for virtual disease management during the COVID-19 outbreak. Selection of telemedicine communication services and interaction modes with regard to its use-case, disease category, and application plays a significant role in the success of remote disease management infrastructures in this scenario and their implication for a better future healthcare system.

Telemedicine in Peru as a Result of the COVID-19 Pandemic: Perspective from a Country with Limited Internet Access

The COVID-19 pandemic contributed to the worldwide implementation of telemedicine because of the need for medical care for patients, especially those with chronic diseases. This perspective paper presents the current situation of telemedicine in Peru, showing advances in regulation, cases of successful implementation, and the current challenges. Access to health should be available to all, and more efforts need to be implemented to offer access to the internet to achieve high-quality telemedicine to all the vulnerable groups in Peru.