Overview

Johns Hopkins evaluated whether triage screening of patients in the emergency department (ED) could be safely and efficiently performed using telescreening rather than in-person screening.

Organization Name

Johns Hopkins Medical Center

Organization Type

• Academic Medical Center

National/Policy Context

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Local/Organizational Context

• Having a provider in triage actively screening patients can help combat the problem of ED overcrowding.
• At some hours, a provider may not be available for triage screening. Therefore, a telescreening pilot program was performed to expand the hours during which a provider could screen in the ED. 
• Given the setting of an academic medical center in an urban area, patient volume generally exceeded capacity of the local ED system. All but the most critically ill patients were forced to wait. 

Patient Population Served and Payor Information

• 3,430 individuals were screened, with an average age of 43. 
• Of those screened, 65-70% were black and 4% were Hispanic.

Leadership

• This innovation had support from emergency department leadership. Drs. Kelen and Razzak were the primary leaders for physicians. Gai Cole was the administrative lead. 

Funding

• The Johns Hopkins School of Medicine Biostatistics, Epidemiology and Data Management Core funded this project.

Research + Planning

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Tools or Products Developed

• Globalmed Clinical Access Station: Two-way audio and visual communication devices with mounted cameras and microphones that can be controlled by telescreening providers. The station has a computer, two monitors, light source, camera, otoscope, and stethoscope (see Multimedia Appendix 1). It uses the ClearSteth stethoscope to tele-auscultate lungs and heart sounds.

Training

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Tech Involved

• Telemedicine software

Team Members Involved

• NPs
• PAs
• Physicians

Workflow Steps

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Budget Details

• Screening provider time
• Technologies (Globalmed Clinical Access Station, Clearsteth, dual-monitor computer and audio/video communication)
• Training time

Where We Are

• Project Dates: April 2016 – August 2016
• Paper Published: May 2019

Outcomes

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Benefits

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Unique Challenges

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Glossary

“Standard orders by health care providers” for a chest pain bundle include CBC, BMP, troponins, ECG, CXR, and aspirin, as defined by the authors.

Sources

Rademacher NJ, Cole G, Psoter KJ, Kelen G, Fan JWZ, Gordon D, Razzak J. Use of Telemedicine to Screen Patients in the Emergency Department: Matched Cohort Study Evaluating Efficiency and Patient Safety of Telemedicine. JMIR Med Inform. 2019 May 8;7(2):e11233. doi: 10.2196/11233. PubMed PMID: 31066698.