TelehealthEmergencyMedicine

Emergency Medicine

Emergency Medicine is the field of medicine dedicated to caring for patients with unforeseen injuries or disease. Patients do not need an appointment to see an Emergency Medicine physician. Emergency Medicine Departments (EDs) can be part of hospitals or might be stand-alone (free-standing) such as urgent cares. Emergency Medicine cares for patients of all different injuries and illnesses – from mild sprains and lacerations to cardiac arrests and severe traumas. There are many specialized fields of Emergency Medicine, including ultrasound, Emergency Medical Services (EMS), disaster medicine, hyperbaric medicine, critical care, informatics, education & simulation, and international medicine. Emergency Medicine physicians complete a 3- or 4-year residency following medical school. Many of these physicians also complete fellowship after residency.

Emergency Medicine Operations

Emergency Medicine includes the pre-hospital care (EMS) and within the ED care of patients. EMS services can be provided through volunteer and career prehospital providers. Many counties have an online medical control system where an operator or paramedic is available to help communicate with on-duty medical control physicians. EMS is also involved in educating the community about what to do when there is a medical emergency.

When patients arrive in the ED, by walking-in or by ambulance, they go through triage. During triage, the patient’s explains their chief complaint to the triage provider, gets their vitals signs checked, and is assigned an Emergency Severity Index (ESI), which stratifies patients based on their acuity. Many EDs have different zones where patients can be cared for, for example a Fast Track zone that sees low acuity patients, an acute zone that cares for moderate acuity patients, and a critical care zone that cares for high acuity patients.

What is Telehealth?

Telehealth is the use of Information Technology (IT) tools to connect with patients and provide medical care through two-way communication between patients and providers.

There are 3 basic categories: Asynchronous - where patient data and images are sent to providers; these providers then send their assessment back to the patient.

Remote Monitoring – which uses sensors to gather patient information

Synchronous – uses telecommunication platforms to connect providers and patients in real-time.

Telehealth devices

There are many devices that can be used to provide telehealth care. In March 2020, the United States Health and Human Services (HHS) granted a waiver for telehealth, stating “HIPAA-covered health care providers may, in good faith, provide telehealth services to patients using remote communication technologies, such as commonly used apps – including FaceTime, Facebook Messenger, Google Hangouts, Zoom, or Skype – for telehealth services, even if the application does not fully comply with HIPAA rules.” Additionally, there are many other third party telehealth platforms and remote monitoring programs that are available for telecommunication within the ED.

Telehealth in the Emergency Department Telehealth in the ED is unique and is used to facilitate triage, provide specialist care to patients (for example, for stroke assessment and management), read imaging, and help with traumas (teletrauma).

Teletriage

Emergency Departments are often crowded and patients may have to wait hours to see a provider. Quickly and efficiently triaging patients is important to make sure that they are evaluated and routed to the correct zone of the ED based on their acuity. Teletriage, where a provider, who is at a different location, can triage patients through a telecommunication. The patient walks into a triage room, is instructed to take their own vitals (or someone helps them), and speaks to the provider through a telehealth device. Teletriage allows providers to efficiently triage many patients and even patients at multiple hospitals during one shift. Teletriage has been found to decrease time to provider and left without being seen rates.

Telestroke

When patients have a stroke, administering appropriate treatment in a short amount of time is important. Treatments of strokes involves a complex medical decision-making process and there is a 4.5 hour window period from the onset of symptoms to administer t-PA. Additionally, neurologists are not available 24/7 at every hospital. Telestroke, which involves a board-certified neurologist at a distant location evaluating a patient, through telecommunication technology, and assessing whether the patient has a stroke and the treatment. Some hospitals also have mobile stroke units, which are ambulances with CT Scanners. Using Telestroke, neurologists can assess the patient, view the CT Scan results, and order treatments while the patient is in the ambulance.

Teleradiology

Patients arrive in EDs 24 hours a day, 7 days a week. Many patients get imaging, such as x-rays, CT scans, and MRIs that need to be read emergently by a board certified radiologists. Although many hospitals have in-house radiologists, teleradiology, where radiologists remotely read and report radiologic studies helps improve time to reads. There are also “night-hawks”, who are radiologists who provide immediate diagnostic interpretation during off-hours.

Teletrauma

In Emergency Medicine, a wide variety of trauma is seen – from minor wounds to major blunt and penetrating traumas. Some patients might need to be intubated, need needle decompressions, and/or chest tubes, require central lines/arterial lines, or need an ED thoracotomy. Some patients might need to be transferred from a rural ED to a level-1 trauma center. With teletrauma, trauma specialists can use telecommunication devices to help provide clinical assessments and plans for traumas, disasters, and mass casualty situations. They can also help guide on-site providers how to perform certain procedures and guide which patients need to be transferred to a different hospital.

Submitted by Samita Heslin