A Double Triage and Telemedicine Protocol to Optimize Infection Control in an Emergency Department in Taiwan During the COVID-19 Pandemic: Retrospective Feasibility Study

Abstract

Background Frontline health care workers, including physicians, are at high risk of contracting coronavirus disease (COVID-19) owing to their exposure to patients suspected of having COVID-19. Objective The aim of this study was to evaluate the benefits and feasibility of a double triage and telemedicine protocol in improving infection control in the emergency department (ED). Methods In this retrospective study, we recruited patients aged ≥20 years referred to the ED of the National Taiwan University Hospital between March 1 and April 30, 2020. A double triage and telemedicine protocol was developed to triage suggested COVID-19 cases and minimize health workers’ exposure to this disease. We categorized patients attending video interviews into a telemedicine group and patients experiencing face-to-face interviews into a conventional group. A questionnaire was used to assess how patients perceived the quality of the interviews and their communication with physicians as well as perceptions of stress, discrimination, and privacy. Each question was evaluated using a 5-point Likert scale. Physicians’ total exposure time and total evaluation time were treated as primary outcomes, and the mean scores of the questions were treated as secondary outcomes. Results The final sample included 198 patients, including 93 cases (47.0%) in the telemedicine group and 105 cases (53.0%) in the conventional group. The total exposure time in the telemedicine group was significantly shorter than that in the conventional group (4.7 minutes vs 8.9 minutes, P<.001), whereas the total evaluation time in the telemedicine group was significantly longer than that in the conventional group (12.2 minutes vs 8.9 minutes, P<.001). After controlling for potential confounders, the total exposure time in the telemedicine group was 4.6 minutes shorter than that in the conventional group (95% CI −5.7 to −3.5, P<.001), whereas the total evaluation time in the telemedicine group was 2.8 minutes longer than that in the conventional group (95% CI −1.6 to −4.0, P<.001). The mean scores of the patient questionnaire were high in both groups (4.5/5 to 4.7/5 points). Conclusions The implementation of the double triage and telemedicine protocol in the ED during the COVID-19 pandemic has high potential to improve infection control.

How to keep patients and staff safe from accidental SARS-CoV-2 exposure in the emergency room: Lessons from South Korea’s explosive COVID-19 outbreak

“…Telemedicine can be useful for improving infection control during the COVID-19 pandemic. 17,24,25 To smooth the flow of patients, key personnel from the various departments (eg, administration, infectious diseases, respiratory diseases, emergency medicine, COVID-19 general care and ICU nursing teams, and the infection control team) conducted real-time communication using a mobile messaging application to assess the availability of beds, patient acceptance capabilities, and hospitalization process. The integrated response between our team representative and the out-of-hospital emergency system operated by the local government was critical in managing COVID-19 patients properly and preventing accidental SARS-CoV-2 exposure in each ER.…”

Telemedicine Awareness, Knowledge, Attitude, and Skills of Health Care Workers in a Low-Resource Country During the COVID-19 Pandemic: Cross-sectional Study

“…The COVID-19 pandemic has affected traditional in-person health care services. New strategies and approaches, including telemedicine and telehealth services, must be implemented to facilitate video consultations and the use of mobile apps, with the goals of delivering medical advice, diagnosis, and treatment to reduce the risk of infection [ 9 , 10 ]. Telemedicine and telehealth services are especially important for individuals without COVID-19 seeking medical treatment during the pandemic, especially those with chronic or acute illnesses.…”

How to Keep COVID-19 at Bay: A Taiwanese Perspective

“…This strategy helped to save time during sample collection and reduced the use of personal protection equipment [ 13 ]. In addition, one hospital introduced a strategy of including double triage and a telemedicine protocol in the emergency department to help reduce the exposure time and risk of contracting SARS-CoV-2 for frontline healthcare workers when managing patients suspected of having COVID-19 [ 14 ].…”