It’s a well-documented indisputable fact that telehealth use exploded throughout the nation in 2020, spurred by the Covid-19 pandemic. However a number of hurdles rapidly emerged, together with the query of how finest to triage sufferers so those that are suited to care through telehealth are directed to these companies.
To assist tackle this difficulty, College of California Los Angeles Well being spent months surveying its frontline physicians and understanding the boundaries to efficient digital care supply. They then created telehealth-specific triage protocols, well being system leaders wrote in an article for NEJM Catalyst.
Demand for telehealth spiked as soon as Covid-19 circumstances started spreading and lockdowns proliferated nationwide. At UCLA Well being, telehealth visits within the division of drugs elevated from lower than 1% on March 9 to 55% on April 18 — a virtually 50-percentage level bounce in fewer than 50 days. By November, telehealth utilization had leveled off to round 25% of all visits.
In April and July 2020, UCLA Well being surveyed its frontline main care physicians on how the transition to telehealth had affected their capacity to ship care.
The April survey, which polled 228 physicians, discovered that 52% of the care that main care physicians routinely present could possibly be carried out through telehealth with out compromising high quality.
Based mostly on the outcomes of the second survey, which included 232 responses, UCLA Well being recognized signs that would assist the system direct sufferers to the suitable sort of go to, whether or not in particular person or through telehealth. Physicians ranked signs like chest ache, shortness of breath and ear ache or listening to modifications as being the least acceptable to handle through a video go to. Physicians additionally indicated sure affected person components made it tougher to offer efficient care by telehealth, together with poor cognitive perform and the affected person being older than 70 years.
“These outcomes emphasize that the power to ship high-quality care through telehealth is pushed by each the presenting scientific concern and patient-specific components,” the article authors wrote.
UCLA Well being created a pilot telehealth triage protocol for sufferers scheduling an outpatient go to inside its division of drugs. The protocol consists of each a screening for Covid-19 signs, primarily based on CDC tips, and a screening to find out telehealth appropriateness, primarily based on suggestions from UCLA Well being’s physicians. [Click to enlarge image]
The telehealth appropriateness screening requires sufferers to reply a sequence of yes-or-no questions. These embody questions like “Are you at present experiencing chest ache or coronary heart palpitations?” and “Are you involved that your signs require fast or emergent consideration?”
There have been some challenges associated to the event of those protocols nonetheless, the authors famous, together with attaining a consensus on the correct screener questions and modifying name middle workflows to combine the brand new triage questions.
“We urge well being methods to hunt the attitude of frontline employees and sufferers to tell the design of a telehealth-specific triage protocol as a result of these people are in the very best place to speak the distinctive wants of the inhabitants being served and the present capabilities of well being know-how,” the authors wrote.
As well as, the authors provided the next nuggets of recommendation for well being methods contemplating deploying telehealth-specific triage protocols:
1. Create a multidisciplinary group to evaluate and implement modifications to the prevailing protocols.
2. Take into account the dangers linked to each digital care and in-person care when growing the protocols.
3. Develop efficiency metrics and get suggestions frequently from well being system employees and sufferers.
“The fast improve in telehealth utilization throughout the pandemic has opened up a brand new medium for our sufferers to hunt and obtain care, and we imagine that as our triage protocols enhance so will our capacity to make sure sufferers obtain well timed and top quality care irrespective of whether or not they’re seeing suppliers in clinic or through telehealth,” Dr. Daniel Croymans, medical director of high quality at UCLA Well being’s division of drugs and one of many article’s authors, stated in an e mail.
Photograph credit score: Sorbetto, Getty Photos, UCLA Well being/NEJM Catalyst