Perceptions of Rural Emergency Department Providers regarding Telehealth-Based Care: Perceived Competency, Satisfaction with Care and Tele-ED Patient Disposition

Abstract

Introduction: This study assesses rural providers' perceptions of their ability to deliver high quality care via telehealth compared to usual care, and whether attending providers perceive that emergency department (ED) telehealth visits influence clinical reasoning in regard to patient disposition, specifically in tele-behavioral and tele-neurological cases. Methods: A cross-sectional survey was conducted of 134 ED providers (nurses [n = 126] and physicians [n = 8]) who were working in five Midwestern critical access hospitals (response rate 83%). Descriptive, correlational and stepwise regression analyses were employed to evaluate provider perceptions of 1) competency level in telehealth delivery, 2) patient health outcomes, 3) access to continuing education in telehealth, and 4) clinical influence of telehealth visit. Evaluation of preliminary set of N = 100 telehealth cases were assessed for influence of telehealth on clinical reasoning of attending physicians regarding patient disposition. Results: The majority (67%; n = 90) of participants had at least minimal experience with telehealth care delivery, with an average of 1 -2 visits in teleneurology, and 3 -4 visits in telebehavioral cases. Providers rated their overall mean competency level in telehealth care delivery as 3.01/5.00 based on a 5 point "novice (1) to expert" (5) scale. Mean scores for providers perceived competency level in 7 evidence-based sub-categories for telehealth care delivery were self-reported as relatively low to mid-range values, ranging from 2.64 -3.57/5.00. Stepwise linear regression analysis of whether all providers "would recommend telehealth to their family and friends" revealed two predictors for model of best fit (n = 81; p < 0.000; R 2 = 0.598): 1) their percep-

Patient and Care Team Perspectives of Telemedicine in Critical Access Hospitals

“…While our quality of care findings align with some previous literature, 13 care teams in the current analysis overwhelmingly would recommend telemedicine, whereas some clinicians in prior work would not recommend telemedicine. 14 In terms of communication, in line with existing literature, some patients still preferred in-person visits, 15 a view also shared by some care team members. Workflow and technology barriers were raised, corroborating existing work, 13 but actionable solutions (eg, adding care team-only time before visits or verbalizing when to move stethoscopes) were also identified.…”

Telehealth Decreases Rural Emergency Department Wait Times for Behavioral Health Patients in a Group of Critical Access Hospitals

“…The evaluation and outcomes of the participating rural ED health care provider teams have been reported elsewhere in relationship to perceptions of (1) their competency level, (2) the study's telehealth equipment, and (3) the implementation process in the participating rural EDs. 20 Initial feedback provided by the ED health care provider teams during 2015 included the following: (1) poor internet connectivity and (2) cumbersome equipment that was too prone to breakage for telebehavioral visits.…”

Telehealth in emergency medicine: A consensus conference to map the intersection of telehealth and emergency medicine

“…Recognizing that EM telehealth is relatively new, there is a need for evaluation studies of EM health care professionals' perception to validate and gain acceptance as part of EM practice. [15][16][17] In 2016 the American College of Emergency Physicians (ACEP) indicated that, with regard to telehealth, "an appropriate and adequate examination to establish a diagnosis or underlying condition" should be performed. 18 Further, the "technology used must be adequate to enable an examination similar to that possible in a face-toface encounter."…”