Lessons From Tele-Emergency: Improving Care Quality And Health Outcomes By Expanding Support For Rural Care Systems

Mueller, Keith J.; Potter, Andrew J.; MacKinney, A. Clinton; Ward, Marcia M.

doi:10.1377/hlthaff.2013.1016

Cited by 94 publications

(80 citation statements)

References 20 publications

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“…Emergency telemedicine services are unique compared with other areas of telemedicine because needs are typically immediate, requiring real-time teleophthalmology, and often have an interactive audio or video component. 2 This section reviews the opportunity for teleophthalmology in the emergency setting in the United States, summarizes tele-emergency models applicable to ophthalmology, and discusses barriers and potential policy implications.…”

Section: Hospital-based Evaluationsmentioning

confidence: 99%

“…Mueller et al 2 describe 3 models of tele-emergency care deployment.

a) Model 1: A central ED physician providing consultative services to nonphysicians at distant sites.

b) Model 2: A central ED physician providing consultative services to multiple smaller EDs at distant sites.

c) Model 3: A specialist (cardiology, neurology, trauma, ophthalmology) providing consultative services to physicians at distant EDs.

…”

Section: Hospital-based Evaluationsmentioning

confidence: 99%

“…2 The first model addresses all aspects of the tele-emergency consultation, and the second model is best suited for complex cases that may require transfer of care. A model well suited to ophthalmology would likely be a combination of the first and third models.…”

Section: Hospital-based Evaluationsmentioning

confidence: 99%

“…Tele-emergency services have proven effective in bringing expert consultation to frontline providers, “permit[ing] accurate and efficient diagnosis and treatment and reducing unnecessary transfers.” 2 A survey of 292 administrators and clinicians across 71 hospitals involved with telemedicine found 95% of respondents agreed and 61% strongly agreed with the statement that “tele-emergency improves the quality of care at my facility.” 2 Frontline providers believe live consultation improves patient care compared with traditional models and provides useful confirmation of diagnosis and treatment. 2 In addition, telemedicine serves to educate local providers and increase provider and patient confidence in the care provided.…”

Section: Hospital-based Evaluationsmentioning

confidence: 99%

“…2 In addition, telemedicine serves to educate local providers and increase provider and patient confidence in the care provided. 2 Backup specialty input via telemedicine services has the potential to make an infrequent diagnosis for the distant clinician more routine.…”

Section: Hospital-based Evaluationsmentioning

confidence: 99%

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The Current State of Teleophthalmology in the United States

et al. 2017

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Telemedicine services facilitate the evaluation, diagnosis, and management of the remote patient. Telemedicine has rapidly flourished in the United States and has improved access to care, outcomes, and patient satisfaction. However, the use of telemedicine in ophthalmology is currently in its infancy and has yet to gain wide acceptance. Current models of telemedicine in ophthalmology are largely performed via “store and forward” methods, but remote monitoring and interactive modalities exist. Although studies have examined the effects of telemedicine, few reports have characterized its current status. We perform a descriptive analysis of the current state of teleophthalmology in the United States. We describe the use of teleophthalmology in the hospital and outpatient settings. We also review the applications to retinopathy of prematurity, diabetic retinopathy, age-related macular degeneration, and glaucoma, as well as anticipated barriers and hurdles for the future adoption of teleophthalmology. With ongoing advances in teleophthalmology, these models may provide earlier detection and more reliable monitoring of vision-threatening diseases.

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Section: Hospital-based Evaluationsmentioning

confidence: 99%

“…Mueller et al 2 describe 3 models of tele-emergency care deployment.

a) Model 1: A central ED physician providing consultative services to nonphysicians at distant sites.

b) Model 2: A central ED physician providing consultative services to multiple smaller EDs at distant sites.

c) Model 3: A specialist (cardiology, neurology, trauma, ophthalmology) providing consultative services to physicians at distant EDs.

…”

Section: Hospital-based Evaluationsmentioning

confidence: 99%

Section: Hospital-based Evaluationsmentioning

confidence: 99%

Section: Hospital-based Evaluationsmentioning

confidence: 99%

Section: Hospital-based Evaluationsmentioning

confidence: 99%

See 3 more Smart Citations

The Current State of Teleophthalmology in the United States

et al. 2017

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Supply and Perceived Demand for Teleophthalmology in Triage and Consultations in California Emergency Departments

2016

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IMPORTANCE Determining the perceived supply and potential demand for teleophthalmology in emergency departments could help mitigate coverage gaps in emergency ophthalmic care. OBJECTIVE To evaluate the perceived current need for and availability of ophthalmologist coverage in California emergency departments and the potential effect of telemedicine for ophthalmology triage and consultation. DESIGN, SETTING, AND PARTICIPANTS Surveys were remotely administered to 187 of the 254 emergency departments throughout California via the telephone and Internet from June 30 to September 23, 2014. Emergency department nurse managers and physicians from all emergency departments listed in the California Office of Statewide Health Planning and Development database were individually surveyed to assess facility characteristics and resources as well as the perceived usefulness of teleophthalmology consultation. Data analysis was conducted from June 30, 2014, to March 11, 2015. MAIN OUTCOMES AND MEASURES Perceived availability of ophthalmology consultation coverage and perceived effect of telemedicine ophthalmology consultation at each facility. RESULTS Of the 187 emergency departments surveyed, 18 of 37 rural facilities (48.6%) reported availability of emergency ophthalmology coverage, compared with 112 of 150 nonrural facilities (74.7%). Rural facilities reported a mean (SD) of 23.72 (14.15) miles between the facility and referral location, while nonrural facilities reported a mean of 4.41 (10.23) miles (19.3% difference). On a scale of 1 to 5 (where 1 signifies very low value and 5 signifies very high value), 124 of 187 nurse managers (66.3%) and 80 of 121 physicians (66.1%) rated teleophthalmology as having high or very high value for triage purposes. The most frequently cited potential advantage of emergency teleophthalmology was assistance in patient triage and immediate real-time electronic communication, and the most frequently cited potential disadvantages were unknown cost of contracting and maintenance and concern that eye trauma might make photographs or videos less conclusive. CONCLUSIONS AND RELEVANCE Availability of ophthalmology coverage for emergency eye care is limited, particularly among rural emergency departments in California. Surveyed emergency department nurse managers and physicians indicated moderately high interest and perceived value for a teleophthalmology solution for remote triage and consultation. Overall, the study suggests that teleophthalmology could play a role in mitigating coverage gaps in emergency ophthalmic care and could be further investigated through similar studies in other regions.

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Emergency physician perspectives on using telehealth with older adults during COVID‐19: A qualitative study

et al. 2021

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Objectives Emergency medicine physicians have played a pivotal role throughout the coronavirus disease 19 (COVID‐19) pandemic through in‐person and remote management and treatment. Our primary objectives were to understand emergency medicine physicians’ experiences using telehealth throughout the pandemic, any facilitators/barriers to successful usage, lessons learned during implementation, and successful/abandoned strategies used to engage with older adults. Methods Using a semi‐structured interview guide, we conducted 30‐min interviews. We used purposeful sampling to recruit emergency medicine physicians from all United States regions, rural–urban settings, and academic and community practices, who reported caring for patients 65 years or older in‐person or virtually during the pandemic. Interviews were audio‐recorded, transcribed, double‐coded, and analyzed for emergent themes using framework analysis. Results A total of 15 in‐depth interviews were completed from September to November 2020. Physicians had a median age of 37 years, 7 were women, and 9 had experience with telehealth before the pandemic. We identified several themes: (1) there were various motivations for telehealth use; (2) telehealth was used primarily to supplement, not replace in‐person care; (3) most platforms were easy to use; (4) patients and caregivers had high acceptability of telemedicine; and (5) older adults with sensory and cognitive impairments often relied on caregivers. Emergency medicine physicians played a critical role during primary care office closures during the first wave—dispelling misinformation about COVID‐19, triaging patients to testing and treatment, and providing care that would otherwise have been deferred. Conclusions Our data show that telemedicine gained acceptability among emergency medicine physicians and provided options to patients who may have otherwise deferred care. These findings can inform future healthcare delivery for acute care needs or pandemic responses.

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Lessons From Tele-Emergency: Improving Care Quality And Health Outcomes By Expanding Support For Rural Care Systems

Cited by 94 publications

References 20 publications

The Current State of Teleophthalmology in the United States

The Current State of Teleophthalmology in the United States

Supply and Perceived Demand for Teleophthalmology in Triage and Consultations in California Emergency Departments

Emergency physician perspectives on using telehealth with older adults during COVID‐19: A qualitative study

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