329 Using Digital Health to Enhance Medical Screening Exam in the Emergency Department

Abstract

Surges in patient arrivals put stress on emergency department (ED) resources contributing to increased time-to-provider, increased walk-outs and decreased patient satisfaction. A medical screening exam (MSE) performed by a Provider-in-Triage (PIT) has been shown to both aid in early identification of seriously ill patients as well as those with non-critical illness. PIT assessments are frequently encumbered by interruptions as the provider navigates through the physical space of the ED. Research suggests that so-called “task switching” causes disruption in the primary task and may contribute to error. We sought to enhance our MSE process by incorporating digital health / telemedicine during peak hours. Specifically, we compared the Provider-In-Triage (PIT) model to a remote Telemedicine medical screening exam (TeleMSE) which had the enhanced capability to quickly navigate between 3 patient triage stations without interruption in work flow. Our hypothesis was that TeleMSE would improve time-to-provider and patient satisfaction while decreasing walk-outs. We conducted a retrospective observational study at a single urban academic tertiary care center, with an annual ED census of 96,000 visits. All 3 processes (PIT MSE, single-station TeleMSE and multi-station TeleMSE) were launched sequentially. The following metrics were analyzed: 1) time-to-provider (initial and full) and 2) total number of patients screened per hour. Initial time-to-provider was defined as the time to the PIT MSE or TeleMSE encounter during which the patients had a brief assessment done by a provider who placed necessary orders to initiate care. Full time-to-provider was defined as the time patients saw a local provider who determined the need for further work-up and disposition. Data on ESI (Estimated Severity Index) level, sex, and age were collected to assess for potential confounding. Data were abstracted from March 1, 2017-May 31, 2017; June 1, 2017-September 14, 2017 and September 15, 2017-December 10, 2017 for PIT MSE, singles station TeleMSE and multi-station TeleMSE respectively. PIT had an average of 3.7 patients per hour MSE encounter, with a median time-to-provider initial evaluation at 21 minutes and a full evaluation at 61.8 minutes. Single-station TeleMSE performed an average of 3.12 patients per hour, with a median time-to-provider initial evaluation at 10.8 minutes and a full evaluation at 30.6 minutes. Lastly, the multi-station TeleMSE model performed 4.8 patients per hour, with an initial time-to-provider evaluation of 15 minutes and a full evaluation at 48.6 minutes. Walk out rates were 4.3%, 4.3%, and 4.1% for PIT, single-station tele MSE and multi-station TeleMSE respectively. Initial results suggest that the TeleMSE process is associated with decreased time-to-provider in comparison to the PIT model. This may be due to decreased interruptions and streamlined work flow. With remote access it also allows for flexible staffing increases during surge and peak times. Multi-station TeleMSE was associated with increased rate of patients seen per hour in comparison to single station TeleMSE. The TeleMSE model has the potential to positively impact the Medical Screening Exam process and patient care.