Abstract
BackgroundThe benefits of telemedicine include cost savings and decentralized care. Video consultation is one form that enables early detection of deteriorating patients and promotion of self-efficacy in patients who are well but anxious. Abdominal pain is a common symptom presented by patients in emergency departments. These patients could benefit from video consultation, as it enables remote follow-up of patients who do not require admission and facilitates early discharge of patients from overcrowded hospitals.ObjectiveThe study aimed to evaluate the safety and efficacy of the use of digital telereview in patients presenting with undifferentiated acute abdominal pain.MethodsThe SAVED study was a prospective randomized controlled trial in which follow-up using existing telephone-based telereview (control) was compared with digital telereview (intervention). Patients with undifferentiated acute abdominal pain discharged from the emergency department observation ward were studied based on intention-to-treat. The control arm received routine, provider-scheduled telereview with missed reviews actively coordinated and rescheduled by emergency department staff. The intervention arm received access to a platform for digital telereview (asynchronous and synchronous format) that enabled patient-led appointment rescheduling. Patients were followed-up for 2 weeks for outcomes of service utilization, efficacy (compliance with their disposition plan), and safety (re-presentation for the same condition).ResultsA total of 70 patients participated, with patients randomly assigned to each arm (1:1 ratio). Patients were a mean age of 40.0 (SD 13.8; range 22-71) years, predominantly female (47/70, 67%), and predominantly of Chinese ethnicity (39/70, 56%). The telereview service was used by 32 patients in the control arm (32/35, 91%) and 18 patients in the intervention arm (18/35, 51%). Most patients in control (33/35, 94%; 95% CI 79.5%-99.0%) and intervention (34/35, 97%; 95% CI 83.4%-99.9%) arms were compliant with their final disposition. There was a low rate of re-presentation at 72 hours and 2 weeks for both control (72 hours: 2/35, 6%; 95% CI 1.0%-20.5%; 2 weeks: 2/35, 6%, 95% CI 1.0%-20.5%) and intervention (72 hours: 2/35, 6%; 95% CI 1.0%-20.5%; 2 weeks: 3/35, 9%, 95% CI 2.2%-24.2%) arms. There were no significant differences in safety (P>.99) and efficacy (P>.99) between the two groups.ConclusionsThe application of digital telereview for the follow-up of patients with abdominal pain may be safe and effective. Future studies are needed to evaluate its cost-effectiveness and usefulness for broader clinical application.Trial RegistrationISRCTN Registry ISRCTN28468556; http://www.isrctn.com/ISRCTN28468556.
Highlights
Existing literature on telemedicine suggests that it enables cost savings and improved health care access for patients with diverse illnesses [1,2]
Patient and provider acceptance of video consultation has grown in recent years, and over two-thirds of respondents to a survey of patient and caregiver acceptance conducted in the emergency department of Singapore General Hospital were comfortable using mobile technology to share information [7]
Patients from the emergency department observation ward with severe undifferentiated illnesses that did not meet clinical criteria for hospital admission were recruited. This cohort represents a segment of the population of patients in the emergency department for whom the decision is delayed by clinical uncertainty [14,15]; the recruitment of patients discharged from the emergency department observation ward allowed investigators to stress-test the appropriateness of disposition assigned by digital telereview as well as patient adherence to recommendations, since telephone-based telereview is routinely conducted within 48 to 72 hours of discharge for patients with undifferentiated illness as a fail-safe measure that enables early detection of patients with deteriorating clinical condition
Summary
Existing literature on telemedicine suggests that it enables cost savings and improved health care access for patients with diverse illnesses [1,2] These reports have fueled a rise in the adoption of telemedicine for these applications in various clinical settings [3], allowing new models for decentralized care that may help alleviate shortages in health care resources and help encourage self-management by patients where appropriate [4]. Abdominal pain is a common symptom presented by patients in emergency departments These patients could benefit from video consultation, as it enables remote follow-up of patients who do not require admission and facilitates early discharge of patients from overcrowded hospitals
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