Background: Telemedicine has been deployed by health care systems in response to the COVID-19 pandemic to enable health care workers to provide remote care for both outpatients and inpatients. Although it is reasonable to suspect telemedicine visits limit unnecessary personal contact and thus decrease the risk of infection transmission, the impact of the use of such technology on clinician workflows in the emergency department is unknown. Objective: This study aimed to use a real-time locating system (RTLS) to evaluate the impact of a new telemedicine platform, which permitted clinicians located outside patient rooms to interact with patients who were under isolation precautions in the emergency department, on in-person interaction between health care workers and patients. Methods: A pre-post analysis was conducted using a badge-based RTLS platform to collect movement data including entrances and duration of stay within patient rooms of the emergency department for nursing and physician staff. Movement data was captured between March 2, 2020, the date of the first patient screened for COVID-19 in the emergency department, and April 20, 2020. A new telemedicine platform was deployed on March 29, 2020. The number of entrances and duration of in-person interactions per patient encounter, adjusted for patient length of stay, were obtained for pre- and postimplementation phases and compared with t tests to determine statistical significance. Results: There were 15,741 RTLS events linked to 2662 encounters for patients screened for COVID-19. There was no significant change in the number of in-person interactions between the pre- and postimplementation phases for both nurses (5.7 vs 7.0 entrances per patient, P=.07) and physicians (1.3 vs 1.5 entrances per patient, P=.12). Total duration of in-person interactions did not change (56.4 vs 55.2 minutes per patient, P=.74) despite significant increases in telemedicine videoconference frequency (0.6 vs 1.3 videoconferences per patient, P<.001 for change in daily average) and duration (4.3 vs 12.3 minutes per patient, P<.001 for change in daily average). Conclusions: Telemedicine was rapidly adopted with the intent of minimizing pathogen exposure to health care workers during the COVID-19 pandemic, yet RTLS movement data did not reveal significant changes for in-person interactions between staff and patients under investigation for COVID-19 infection. Additional research is needed to better understand how telemedicine technology may be better incorporated into emergency departments to improve workflows for frontline health care clinicians.

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中文翻译：

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在 COVID-19 期间使用实时定位系统评估远程医疗对急诊科的影响：观察性研究

背景：为应对 COVID-19 大流行，卫生保健系统已部署远程医疗，以使卫生保健工作者能够为门诊和住院患者提供远程护理。尽管怀疑远程医疗访问限制了不必要的个人接触从而降低了感染传播的风险是合理的，但使用此类技术对急诊科临床医生工作流程的影响尚不清楚。目标：本研究旨在使用实时定位系统 (RTLS) 来评估新的远程医疗平台的影响，该平台允许位于病房外的临床医生与在急诊科采取隔离预防措施的患者进行互动。卫生保健工作者和患者之间的人际互动。方法：使用基于徽章的 RTLS 平台进行了事前分析，以收集运动数据，包括护理人员和医生工作人员在急诊室病房内的入口和停留时间。移动数据是在 2020 年 3 月 2 日（即急诊科第一个接受 COVID-19 筛查的患者的日期）到 2020 年 4 月 20 日之间捕获的。新的远程医疗平台于 2020 年 3 月 29 日部署。入口数量和持续时间在实施前和实施后阶段获得了针对患者住院时间调整的每次患者面对面互动的数量，并与 t 检验进行比较以确定统计显着性。结果：对于接受 COVID-19 筛查的患者，有 15,741 次 RTLS 事件与 2662 次就诊相关。护士（每位患者 5.7 次与 7.0 次进入，P=.07）和医生（每位患者 1.3 次与 1.5 次进入，P=.12）在实施前和实施后阶段之间的面对面互动次数没有显着变化）。尽管远程医疗视频会议的频率（每位患者 0.6 对 1.3 次视频会议，每日平均变化 P<.001）和持续时间显着增加，但面对面互动的总持续时间并未改变（每位患者 56.4 分钟对 55.2 分钟，P=.74） （每位患者 4.3 分钟 vs 12.3 分钟，每日平均值变化 P<.001）。结论：远程医疗被迅速采用，目的是在 COVID-19 大流行期间最大限度地减少卫生保健工作者接触病原体，然而，RTLS 运动数据并未显示工作人员和接受 COVID-19 感染调查的患者之间面对面互动的重大变化。需要更多的研究来更好地了解远程医疗技术如何更好地融入急诊科，以改善一线医疗保健临床医生的工作流程。

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