Authors: Kelly J. Ko, PhD, Michael M. Kurliand, MS, BSN, RN, Kevin M. Curtis, MD, MS, Christopher M. Palmer, MD, Michelle S. Naimer, MD, MHSc, Scott W. Rodi, MD, MPH, Zia Agha, MD, MS
Background: COVID-19 has led to a dramatic increase in the use of telehealth services, particularly with older adults, who are at highest risk of potential infection and mortality. As a result, Emergency Departments (EDs) around the country are now leveraging telehealth as a key tool in a variety of settings for COVID-19 and non-COVID related conditions.
Participants: Three EDs participating in the San Diego, California Senior Emergency Care Initiative, and the EDs of Dartmouth-Hitchcock in Lebanon, New Hampshire, Sinai Health in Toronto, Canada, and Washington University in St. Louis, Missouri contributed to this report. We outline 3 specific models illustrating how telehealth is being used to increase access and care for older adults during COVID-19. In each model we emphasize needs of unique populations, and provide example workflows, and staffing considerations.
Real-world examples: First, in nursing homes a primary goal is to determine if facilities can treat in place, or transfer. A common approach is a provider-to-provider model where EDs consult directly with nursing home providers. Second, in rural and critical access hospitals telehealth can provide access to multi-specialty expertise when managing complex patients. In rural settings, establishing a new telehealth program may not be feasible. However, partnering with an organization that already has an existing telehealth platform is the fastest route to implementation. Finally, telehealth can be used for forward triage in primary and ED settings. The forward triage focus is on prioritizing which patients can be seen virtually and, if needed, determining the ED or other site as the best location for care.
Conclusions: As telehealth utilization increases during COVID-19, telehealth can maintain medical contact while helping decrease spread of infection during this public health crisis. Addressing the healthcare needs of vulnerable seniors by virtual connection minimizes exposure to infection for patients and ED providers, positioning telehealth as a critical tool in combating the current pandemic.
Key Words: Geriatrics, COVID-19, Telehealth, Post-acute, Rural, Forward triage
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