Effects of Telehealth Use for Rapid Screening, Treatment, and Discharge of Patients with Low-Acuity Conditions in the Emergency Department

项目总结/文摘

PROJECT SUMMARY/ABSTRACT This proposal presents a research project focused on the study of a novel emergency telehealth strategy which performs rapid screening, treatment, and discharge of patients presenting to the emergency department (ED) with a low-acuity condition. This care delivery strategy facilitates timely discharges for eligible patients from an ED triage room in a way that reserves ED capacity for patients with higher acuity or more complex presentations that require an in-person evaluation. Clarifying guidance from the federal government pertaining to the use of telehealth to conduct medical screening exams under the Emergency Medical Treatment and Labor Act (EMTALA) made the implementation of the ETD workflow possible as of March 2020. Given the novelty of this EMTALA exception, the use of telehealth to complete the assessment and discharge of a patient from the ED without an in-person examination has not yet been evaluated. A better understanding of the efficacy and safety of this care delivery strategy is needed to guide longer-term federal policies that support Evaluate, Treat, Discharge (ETD) telehealth care for appropriate emergency department encounters. The proposed project will assess the effects of this telehealth strategy on ED throughput, ED crowding, and patient outcomes after discharge. This care delivery strategy not only has potential to improve emergency preparedness, but also it can address long-standing pre-pandemic challenges with ED crowding. Additionally, project findings will generate implications for ED operations and inform practice leaders on the efficacy and safety of adopting this new approach to emergency telehealth. The study addresses priorities highlighted in PA-18-794 by focusing on an innovative telehealth strategy that harnesses technology with the goal of improving emergency care quality and patient outcomes. It also directly addresses AHRQ priority populations, with a focused analysis of outcomes disparities among racial/ethnic minorities and low-income individuals and the inclusion of sites located in inner city and rural settings. The project will be executed by a multidisciplinary team with expertise in emergency health services research, telehealth, and health econometric modeling. Since the data for this study is readily accessible to the study team, with prior experience working with the data sources and performing the analytic procedures outlined in the proposal, the team is well-positioned to execute the study with timely dissemination of project findings.