Forward Triage Research Articles

Pivoting to teleconsultation for paediatric ophthalmology and strabismus: Our experience during COVID-19 times.

Purpose:The objective is to analyse and report the data of teleconsultations provided to paediatric ophthalmology and strabismus patients during COVID-19 times and to elaborate our experience for guiding future teleconsultation practices to General, paediatric Ophthalmologists and Strabismologists.Methods:Retrospective analysis of electronic medical record data of teleconsultations provided in the department of Strabismus, Paediatric and Neuro-ophthalmology was done. Patients with optic nerve related disorders were excluded. Study period was one month. Statistical analysis of collected data was done using Microsoft excel.Results:A total of 198 patients were provided teleconsultations (an average of seven teleconsultations/day). The final analysis included 161 patients after excluding optic nerve related disorders. The median age was seven years. We had a near equal gender distribution (53% males and 47% females) of whom a third were new cases. Video calling was used in 14%, review of clinical photos shared was used in 53%. Rest of the 33% were given telephonic advice. Allergic conjunctivitis (14%), pseudophakia (9%), strabismus (12%), status post strabismus surgery (8%), cranial nerve palsies (11%) were common diagnoses. 19% (n = 30) were advised/needed visit in emergency services on same or next day.Conclusion:Our experience of teleconsultation during COVID-19 times for paediatric ophthalmology and strabismus patients was very encouraging. Pivoting teleconsultation platform can provide primary eye care to most of the patients and work as essential forward triage for rest. As we continue to further explore the currently available avenues in multimedia such as video conferencing and web/mobile based applications, we believe that tele-ophthalmology platform can provide a reliable service in patient care.

Utility of telemedicine in the COVID-19 era.

Previously it has been demonstrated that telehealth (TH) could help cover the gaps in health attention in remote locations. Today the expanded capabilities have transformed TH delivery, and from the beginning of the coronavirus pandemic, it has remained one of our biggest allies. Telehealth has become a central piece in patient healthcare delivery during COVID-19 pandemic era. Telehealth allows health care services to reach patients in their homes, keeping other patients safe through social distancing and maintaining self-quarantine. Within this administration of health, TH allows health care providers to focus more resources to pandemic usage and at the same time continue caring for the health of non COVID-19 patients. During this time, clinicians are expanding knowledge about TH capabilities, such as application of forward triage as a tool to avoid patient contact in emergency departments. While previously TH was mainly used for primary care needs, specialized and urgent care health is now being utilized more than ever before. These advantages comes with limitations, some of them include a limited physical exam, lack of access to diagnostic testing or imaging, and many other pitfalls and persistent unmet needs. The 2020 pandemic has led to significant improvements leading into the next generation of telemedicine.

“Telethyroidology”: Managing thyroid disorders through telemedicine

The recent coronavirus disease 2019 pandemic has brought telemedicine to the forefront in India. Also guidelines by the Board of Governors of the Medical Council of India have paved the way for the practical application of telemedicine. Thyroid disorders in endocrinology are best suited for the use of telemedicine, for which we have coined the term “telethyroidology.” In this review, we discuss the application of telemedicine to specific thyroid disorders such as hypothyroidism (subclinical and overt), thyrotoxicosis, thyroid nodules, thyroid cancer as well as pregnancy-associated thyroid diseases. “Telethyroidology” covers the entire spectrum of the utility of telemedicine diagnosis, multidisciplinary approach with the involvement of teleradiology and telecytopathology, forward triage of patients needing in-person consults, postthyroidectomy care as well as long-term monitoring. Adoption of telethyroidology can reduce the burden of in-person consultation for endocrinologists at the same time ensuring that their expertise is available to all – ultimately improving diagnosis, treatment, and compliance in thyroid disorders.

Three years experience with forward-site mass casualty triage-, evacuation-, operating room-, ICU-, and radiography-enabled disaster vehicles: development of usage strategies from drills and deployments.

Delineation of the advantages and problems related to the use of forward-site operating room-, Intensive Care Unit (ICU)-, radiography-, and mass casualty-enabled disaster vehicles for site evacuation, patient stabilization, and triage. The vehicles discussed have six ventilated ICU spaces, two ORs, on-site radiography, 21 intermediate acuity spaces with stretchers, and 54 seated minor acuity spaces. Each space has piped oxygen with an independent vehicle-loaded supply. The vehicles are operated by the Dubai Corporate Ambulance Services. Their support hospital is the main trauma center for the Emirate of Dubai and provides the vehicles' surgical, intensivist, anesthesia, and nursing staff. The disaster vehicles have been deployed 264 times in the last 5 years (these figures do not include deployments for drills). Introducing this new service required extensive initial planning and ongoing analysis of the performance of the disaster vehicles that offer ambulance services and receiving hospitals a large array of possibilities in terms of triage, stabilization of priority I and II patients, and management of priority III patients. In both drills and in disasters, the vehicles were valuable in forward triage and stabilization and in the transport of large numbers of priority III patients. This has avoided the depletion of emergency transport available for priority I and II patients. The successful utilization of disaster vehicles requires seamless cooperation between the hospital staffing the vehicles and the ambulance service deploying them. They are particularly effective during preplanned deployments to high-risk situations. These vehicles also potentially provide self-sufficient refuges for forward teams in hostile environments.

Prospective observational comparative study assessing the role of store and forward teledermatology triage in skin cancer

In the UK, patients with suspected cancer should be seen within 2 weeks of referral, and treatment commenced within 62 days. We investigated store-and-forward teledermatology triage for melanoma and squamous cell carcinoma (SCC) at a skin-cancer clinic. Electronic referral and digital photography were assessed together to allocate priority. Data were collected prospectively for 1 year and compared with conventional referral. In the photograph group, we upgraded all patients with malignant lesions who were not referred urgently. In the comparison group, seven patients (9%) were not upgraded and six (8%) were downgraded. Median wait to clinic for photographed patients with melanoma was 14 days and 13.5 days for SCC. Without photographs, urgent cases were seen after a median of 24 days. In the photograph group, all but one melanoma and 60% of patients with SCC were treated within 62 days. In the group without photographs, 68% of patients with melanoma and < 50% of patients with SCC were treated within 62 days. These data support photographic triage as a useful tool for improving prioritization and reducing waiting times.