At the same time, there was no established telehealth procedure in place to support patients who may have been seen in the ED but left prior to medical clearance, refused admission or needed prompt follow-up. 13Īs for the patient perspective, Robinson et al 14 report that based on acute telemedical care in an ED, 80% of patients were satisfied with the explanation of their medical condition and their treatment.ĭuring the start of the COVID-19 pandemic in March and April 2020, ED visits in the Fraser Health Authority (FHA) decreased by 50%. Several studies have shown that telehealth can be successfully used by vulnerable and complex populations, such as the elderly, palliative and mental health patients 10–12, as well as children with special needs. By comparing telehealth visits to in-person visits of common acute conditions, they report that the majority (81.5%) of in-person follow-ups did not result in diagnosis changes while most patients (92%) agreed that the telehealth visit had replaced an in-person visit. Player et al 9 also attest to the quality of care that can be provided using telehealth. Similarly, Davis et al 8 used telemonitoring in a transitional care model following an acute event to show a reduction in all-cause 30-day readmissions by up to 50% with potential to reduce long-term acute care utilisation.
6 7ĭadosky et al 7 showed that telemanagement of heart failure patients in the postacute care continuum reduced rehospitalisation rates. 2–5 The few studies of physician-to-patient virtual care in the acute care setting have demonstrated the safety and benefits of telehealth. The process and referral criteria may require minor modification and must be followed strictly to ensure safety and efficiency in providing telehealth follow-up in the acute care setting.Įmergency telehealth care has predominantly involved consultation between specialists and emergency room (ER) physicians to support rural communities in the provision of acute care services, such as telestroke or tele-ICU (intensive care unit). They had an atypical presentation of abdominal pain and their care was delayed by several hours than if they were to present to the ED for in-person follow-up. One patient was referred for a virtual care follow-up for imaging results that did not meet the referral criteria the patient was diagnosed with a perforated appendicitis. The majority (80%) would like to continue to provide the service. Additionally, based on a physician survey, 80% of providers were satisfied or very satisfied with the overall EVC experience. A patient survey revealed that 75% of respondents were very satisfied or satisfied with telephone virtual care as a follow-up to their emergency department (ED) visit, while 95% would like to continue to receive telephone follow-up care. Through the emergency department virtual care (EVC) pilot project, from May 14 to August 31, 2020, on average 58 telehealth visits were conducted weekly, with 19% of visits reaching unattached patients without a regular primary care provider. For 2 hours daily, an ER physician contacts selected patients by telephone to provide a virtual follow-up based on the patients’ needs. Specific criteria were created for safe referral to virtual follow-up. Patients who did present to the ER left prior to their results being available and some refused admission and critical treatments.Īt the Chilliwack General Hospital ER, a virtual care clinic was established to follow-up on patients after their initial ER visit, providing test results and ensuring patients are not clinically deteriorating at home.
During the COVID-19 pandemic, patients were apprehensive to seek acute care resulting in delayed diagnoses of serious conditions and reduction in emergency room (ER) visits by 50% in the Fraser Health Authority.
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