Apr 30 2020

How ‘Tele-Triage’ Models Work to Keep Patients and Clinicians Safe

By making virtual care the first stop for some emergency department patients, care teams gain greater speed and security.

Prior to the COVID-19 pandemic, incoming patients at a Jefferson Health emergency department might see a clinician on screen before seeing one in person. 

Known as “tele-triage,” the arrangement helps diagnose and direct noncritical cases to the next step in a person’s care journey. By speaking via secure video chat — with patient wait times averaging nine minutes — a doctor or physician assistant can gather information and even approve a discharge without taking up a bed or treatment room. 

Such efficiencies had already cut untreated ED walkouts to fewer than 1 percent in recent months, says Dr. Judd Hollander, senior vice president for healthcare delivery innovation at Thomas Jefferson University. And the ability to separate caretakers and possibly contagious individuals has since become a critical defense. 

“Pre-COVID, it reduced the number of people we had come to the ER asking for help who decided on their own to leave prior to being seen,” Hollander tells HealthTech. “Now, we can evaluate a patient that may or may not have the flu or a cold or COVID, and you don’t have to put a provider in there with them.”

The Philadelphia organization relies on tablets for patients to communicate with care staff, who may be located remotely in a command center, using desktop computers to provide services across multiple facilities. 

Teams use a virtual visit platform called EmOpti, which has facilitated 300,000 remote consults for Jefferson Health and other clients over the past five years, according to a press release from the Wisconsin-based company. 

EmOpti also claims that clinicians can see three times as many patients using the system, a benefit when average national ED wait times exceed 90 minutes.

What Is Tele-Triage, and How Do Healthcare Organizations Use It?

A hub-and-spoke model that can efficiently leverage remote caretakers to provide a first line of consultation — interactions that might spur blood draws, scans or other actions for low-acuity patients — allows onsite ED doctors to focus more on critical cases. 

Nurses, who typically don’t have the same ordering privileges, can provide frontline care by working in tandem with onscreen clinicians to reduce bottlenecks.

“We get their orders written, [patients] get their X-ray taken and get their labs done, they get their EKG done,” Hollander says. “Sometimes they even get their CAT scan done before they get into a patient room, depending on how backed up we are. It’s a major, major advantage.”

At Milwaukee-based Aurora Health Care, which has used the EmOpti platform for several years, the length of ED visits was reduced by an average of 45 minutes.

“It’s a change in how you triage patients,” Paul Coogan, the organization’s president of emergency services, told the biotech news site Xconomy. “There was initially some resistance. The nurses thought it was going to add a lot of time to triage. [But] I think they appreciate having some extra help.”

Other efforts are having a similar impact. Blanchfield Army Community Hospital in Fort Campbell, Ky., uses a telemedicine platform in its busy ED to treat nonemergency cases, mHealth Intelligence reports. Those patients are seen via virtual visit by primary care doctors at an Army medical center more than 400 miles away in Augusta, Ga.

The University of Mississippi Medical Center’s TelEmergency program provides services in some of the state’s rural and critical access hospitals, connecting their emergency rooms in real time to emergency medicine physicians on duty in Jackson, Miss. 

“[W]e don’t have enough providers, and we have a very sick population in most cases,” Michael Adcock, the medical center’s former telehealth director, told PBS NewsHour Weekend in March

The concern isn’t limited to rural areas. 

A 2009 tele-triage implementation at MedStar Washington Hospital Center in Washington, D.C., was crucial to cutting wait times. Emergency room doctors working remotely — free of distractions and other duties — can evaluate and process a higher number of patients per shift, according to a recent American Hospital Association case study. They also can assist partner hospitals when unexpected demand spikes.

READ MORE: Demand for virtual visits has increased by 2,000 percent at one California children’s hospital.

Why Tele-Triage Matters During a Health Emergency

A decrease in the number of emergency departments coupled with a rise in patient visits caused capacity and workflow issues long before the pandemic. Now, staff exposed to COVID-19 (but who are not necessarily sick) pose an added challenge.

“At institutions with ED tele-intake or direct-to-consumer care, quarantined physicians can cover those services, freeing up other physicians to perform in-person care,” wrote Hollander, of Jefferson Health, and his colleague Dr. Brendan Carr in an editorial published last month in The New England Journal of Medicine. “Office-based practices can also employ quarantined physicians to care for patients remotely.”

Treating incoming patients in a separate part of a care facility also helps avoid cross-contamination.

Tablet computers, Carr and Hollander write, can be cleaned between their use by patients “using well-defined infection-control procedures.” Patients who screen positive in ambulatory care settings can be given a tablet and isolated in an exam room. 

Finally, ease of use and interoperability can aid care delivery and avoid technical hiccups during an exchange. A major component is software that can work seamlessly across a variety of devices, says Dr. Edward Barthell, CEO of the EmOpti tele-triage platform.

“This could be a Windows-based tablet — Microsoft Surface, Dell, HP — or even a laptop if needed,” Barthell says. “You can put a half-dozen of these devices around different areas where you need them … split-flow models to keep potential COVID patients away from everyone else coming in with broken arms and heart attacks.”

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