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Background:
Emergency department (ED) overcrowding is a growing challenge worldwide and is associated with prolonged length of stay (LOS), reduced patient satisfaction, and increased burden on healthcare systems. New approaches are needed to improve how patients are evaluated and treated.
Telemedicine has been increasingly integrated into ED care and has shown feasibility and benefits in various settings. Existing models have demonstrated improvements in patient flow, reduced length of stay, and high patient satisfaction. However, despite the growing use of telemedicine in emergency medicine, there is a lack of randomized controlled trials evaluating its effectiveness and safety, particularly in models involving early remote physician assessment prior to ED evaluation.
Purpose:
This study aims to evaluate whether a video consultation with a senior emergency physician before entering the ED can improve the efficiency and quality of care. The study also examines whether physicians can accurately identify which patients need ED evaluation based on a remote assessment, while maintaining patient safety.
Methods:
A total of 200 adults who arrived at the ED were assigned to one of two groups. In the study group, participants had a video consultation with a physician before continuing with standard ED care.
In the control group, participants received standard ED care only.
During the video consultation, the physician performed an initial clinical assessment and could order tests or specialist consultations. The physician was also asked what their recommendation would have been if the participant had been assessed from home. Three possible decisions were recorded:
Outcomes:
The primary outcomes focus on the effectiveness of the intervention. These include:
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Study Group / Telemedicine Group | Experimental | Participants undergo an initial video consultation with a senior emergency physician prior to continuing with standard emergency department care. |
|
| Control Group | No Intervention | Participants receive standard emergency department care without a prior video consultation. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Telemedicine-Based Remote Physician Assessment | Behavioral | Participants undergo an initial video consultation with a senior emergency physician prior to continuing with standard emergency department care. The consultation includes a clinical assessment and may involve ordering diagnostic tests or specialist consultations. |
| Measure | Description | Time Frame |
|---|---|---|
| Emergency Department Length of Stay | Emergency department length of stay, defined as the time from emergency department registration to discharge or hospital admission during the index visit, measured in hours. Data will be extracted from the hospital electronic medical record one week after the visit. | From emergency department registration to the final decision regarding discharge or hospital admission during the index visit, up to 24 hours. |
| Measure | Description | Time Frame |
|---|---|---|
| Return Visits to the Emergency Department | Return visits to the emergency department within one week for the same complaint. | Within one week after the ED visit |
| Accuracy of Physician Assessment for ED Referral |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Sheba Medical Center | Ramat Gan | Israel |
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The ability of physicians to identify participants requiring emergency department evaluation based on the initial video consultation, assessed by comparing physician recommendations to actual clinical outcomes.
| From the baseline physician assessment at the initial video consultation, to the final clinical outcome at the end of the index visit (discharge or hospital admission), up to 24 hours. |
| Patient Satisfaction | Patient satisfaction will be assessed using the Short Assessment of Patient Satisfaction (SAPS) questionnaire, administered via SMS one week after the emergency department visit. The SAPS is a validated 7-item questionnaire that assesses multiple aspects of patient satisfaction. Total scores range from 0 to 28, with higher scores indicating greater patient satisfaction. Scores of 0 to 10 indicate Very dissatisfaction, 11 to 18 indicate dissatisfaction, 19 to 26 indicate satisfaction, and 27 to 28 indicate very high satisfaction. | One week after the ED visit |