104 Barriers and Facilitators to Implementation of a Regional Disaster Teleconsultation System for New England Hospitals and Emergency Departments

Abstract

The Region 1 Disaster Health Response System (RDHRS) Project is developing a novel teleconsultation system to expand regional access to clinical experts in disasters. Our objectives were to identify barriers and facilitators to implementation, and determine willingness to use a regional disaster teleconsultation system at a hospital-level in New England. In Spring 2021, we conducted a telephone survey of all New England hospitals and freestanding EDs (hospitals/EDs) using the National ED Inventory-USA database. Key respondents were emergency managers. We collected hospital/ED information about: notification systems for large no-notice emergency events; access to disaster specialists (toxicology, radiation/nuclear medicine, trauma, burn care, high-consequence infectious disease, critical care); disaster credentialing/privileging requirements of teleconsultants before system use; reliability and redundancy of internet/cellular service; and willingness to use a disaster teleconsultation system to access specialists (primary outcome). We report descriptive statistics as preliminary analysis, and plan to test association of willingness to use with hospital/ED characteristics, access to non-disaster telehealth services, and interstate differences with logistic regression models once ≥80% data collection is complete (by ACEP Research Forum). To date, 121 (64%) of 189 New England hospitals/EDs have responded. Most (89%) are notified of large no-notice events via hospital network emergency notification systems activated at the state level. One in four hospitals/EDs lacked any access to burn and toxicology specialists; ≥80% had in-person, telephone or telehealth access to other disaster specialists. Overall, 76 (63%) hospitals/EDs would require disaster credentialing/privileging of teleconsultants prior to system use where 12 (16%) expected to complete this process in <4 hours, 14 (19%) in 4-24 hours, and 38 (51%) in >24 hours. However, 52 (68%) would use a third-party verification system for disaster privileging. Most hospitals/EDs can reliably stream video in clinical spaces (110, 91%) and maintain cellular service despite internet disruption (83, 75%). Overall, 92 (76%) hospitals/ED were somewhat or very likely to use the RDHRS system to access specialists if a no-notice event affected their hospital. Among the 21 hospitals/EDs somewhat or very unlikely to use the system, leading barriers were sufficient access to specialists (33%) and reluctance to use new technology during a disaster (24%); potential time delays (14%), liability (14%), privacy (10%), and hospital information system security restrictions (10%) were infrequent concerns. Most New England hospitals/EDs have the necessary emergency notification systems, telecommunication infrastructure, and willingness to use a regional disaster teleconsultation system, but policies and procedures to speed disaster privileging are needed for implementation.