Study Objectives
The COVID-19 crisis has highlighted telemedicine as a care delivery tool uniquely suited for a disaster pandemic, where the use of audio and video communication can increase connection while decreasing person to person exposure. Our institution rapidly deployed telemedicine as a tool to improve care inside the Emergency Department: existing telemedicine equipment was redeployed and new equipment purchased to increase connectivity between staff, patients, and patient’s families, and also to reduce the duration and frequency of situations that could transmit viral illness person to person.
Methods
Sixteen telemedicine carts (7 re-purposed; 9 newly acquired) were utilized in order to conserve PPE and mitigate risk for both patients and providers by decreasing in-person exposures at NewYork-Presbyterian/Weill Cornell Medical Center (NYP/WCMC) and NewYork-Presbyterian/Lower Manhattan Hospital (NYP/LMH). Carts consisted of a video monitor, speaker, microphone, and either a fixed internet camera or a point-tilt-zoom internet camera. The carts enabled clinical providers and other hospital staff (social work, care management, etc.) to communicate with patients from their workstations by logging into a shared user account via a designated computer, starting a video call, and using a headset. Incoming calls automatically appeared and were answered on the patient’s screen, removing the need for patients to physically touch the system or have any knowledge as to how to connect. Carts at NYP/WCMC were allocated specifically for COVID-19 isolation rooms. In our urban community hospital (NYP/LMH), carts remained mobile to allow transport to rooms where COVID-19 patients were located given fewer designated isolation rooms.
Results
This was a dynamic, home-grown initiative. After an initial hands-on encounter with the patient, ED providers and hospital-based teams used the carts to connect with patients to complete interviews and share updates or results without repeated exposure risk and donning of PPE. Admitting teams used the carts to have one team member perform a bedside evaluation while the other team members took part from a distance. With the help of our patient services group, carts were also used for virtual interactions between family members and isolated ED patients. Both patients and their families reported that these video interactions helped to reduce the psychological toll of isolation, which has a major impact on overall patient experience. A limitation of cart use was the need to frequently reboot devices and to alter audio settings for adequate performance.
Conclusion
This initiative increased provider-patient communication and attention to staff safety, improved palliative care and patient support services, lowered PPE consumption, and streamlined clinical workflow. The successful introduction of this program in both academic and urban community hospitals suggests that use of similar devices could be beneficial in a variety of ED settings. In particular, such devices can limit situations that increase the risk for person to person disease transmission and can increase the connection between isolated patients and their care teams and families.