Letter to Editor

To the editor:

We congratulate Turer et al¹ on their recently published article “Electronic Personal Protective Equipment: A Strategy to Protect Emergency Department Providers in the Age of COVID-19.”

The ability to remotely perform some components of the emergency department clinical care process has been recognized for several years. The recognition that this approach is particularly valuable in response to the coronavirus disease 2019 (COVID-19) pandemic, and as we plan for a post-COVID world, is important.

The article concentrates on use of electronic video communication between a provider and patient within the same facility, and particularly for intake evaluation of emergency patients. This general concept has value, especially as both emergency departments and inpatient units create “hot zones” and “cold zones” in the effort to systematically segregate patients with high and low risk of COVID-19 (or other dangerous infectious diseases). We believe this strategy is likely to continue for many months at a minimum and is likely to become the “new normal.”

The article references one article on the use of remote evaluation for low-volume emergency intake evaluation. However, this practice has been in use at multiple facilities for years and has been described in both the popular press and peer-reviewed literature. It has been shown to decrease wait times and improve patient flow,² be equivalent to in-person provider-in-triage processes in quality of orders,³ and decrease left-without-being-seen rates.⁴

Unlike the authors’ recommendation to limit the process to low-acuity patients and a single facility, we have seen the process used effectively for as many as 85% of emergency department arrivals and across multiple facilities. The process is effective for virtually all patients with Emergency Severity Index levels 3-5, and even to assist with identification of ambulatory Emergency Severity Index level 2 patients. Moreover, remote intake can be very fast with technology designed for the purpose, with over 20 patient assessments per hour per clinician, and the ability to service multiple emergency departments simultaneously (see Figure 1).

Figure 1.

 High Volume Multi-Hospital Tele-Triage Results.

Finally, we take issue with the authors’ suggestion that video management software designed for consumer use or business conference calls, such as FaceTime, Skype, or Zoom, is the best choice. We understand the temptation to use familiar tools to rapidly respond to the COVID-19 pandemic. But these generic tools were not designed to be optimized for healthcare workflows, and their use often requires significant compromises. Owing to security concerns, HIPAA Journal has now issued the equivalent of an “FDA Black Box Warning” discouraging the use of Zoom in healthcare settings.⁵ Alternative technology specifically designed for secure, high-volume use in emergency department settings is available and should be considered.

Thank you,

Author Contributions

Both authors participated in the data analysis, drafting of the article and final approval.

Conflict of Interest Statement

EB is CEO of and JH is a Senior Advisor for EmOpti, Inc.