Use of Telemedicine for Emergency Triage in an Independent Senior Living Community: Mixed Methods Study.

Kelsi Carolan,Ateev Mehrotra,David C Grabowski,Laura A Hatfield

doi:10.2196/23014

Abstract

BackgroundOlder, chronically ill individuals in independent living communities are frequently transferred to the emergency department (ED) for acute issues that could be managed in lower-acuity settings. Triage via telemedicine could deter unnecessary ED transfers.ObjectiveWe examined the effectiveness of a telemedicine intervention for emergency triage in an independent living community.MethodsIn the intervention community, a 950-resident independent senior living community, when a resident called for help, emergency medical technician–trained staff could engage an emergency medicine physician via telemedicine to assist with management and triage. We compared trends in the proportion of calls resulting in transport to the ED (ie, primary outcome) in the intervention community to two control communities. Secondary outcomes were telemedicine use and posttransport disposition. Semistructured focus groups of residents and staff were conducted to examine attitudes toward the intervention. Qualitative data analysis used thematic analysis.ResultsAlthough the service was offered at no cost to residents, use was low and we found no evidence of fewer ED transfers. The key barrier to program use was resistance from frontline staff members, who did not view telemedicine triage as a valuable tool for emergency response, instead perceiving it as time-consuming and as undermining their independent judgment.ConclusionsEngagement of, and acceptance by, frontline providers is a key consideration in using telemedicine triage to reduce unnecessary ED transfers.

Highlights

Nationwide, roughly one million people live in independent senior living communities [1], and residents often receive fragmented medical services
To assess whether the change observed in the intervention community could be driven by growth of telemedicine, we compared the observed change in the emergency department (ED) transport rate at the intervention community to the theoretical change, in which every telemedicine call that did not result in ED transport had instead resulted in transport
Reducing resident transports to the ED was not a goal embraced by safety staff, who described approaching all calls with the assumption that transport would likely be necessary

Summary

Introduction

Nationwide, roughly one million people live in independent senior living communities [1], and residents often receive fragmented medical services. Senior living communities provide many amenities, but residents typically receive medical care from off-site physicians. When residents of senior living communities experience a new medical issue, the lack of an on-site physician may lead to unnecessary transfers to the emergency department (ED). Introducing on-site medical services within independent living communities may safely prevent unnecessary transfers [2,3] but may be cost-prohibitive. We studied the introduction of telemedicine for http://www.jmir.org/2020/12/e23014/. Chronically ill individuals in independent living communities are frequently transferred to the emergency department (ED) for acute issues that could be managed in lower-acuity settings.

Methods

Results

Discussion

Conclusion