Telescreening and CNAs to meet growing demands on emergency departments

Abstract

<p>Session F presented Friday, September 28, 11:30 am-12:30 pm</p> <p><strong>Purpose:</strong> Emergency departments across the United States are providing care to larger volumes of patients and stressing their current capacity to provide timely and safe services. New approaches are essential to meet this growing demand. One solution to expedite emergency care in is the medical screening evaluation, whereby patients who are not triage as critically ill are interviewed and examined shortly after their arrival by an advanced practice provider. The use of telemedicine technology is able to bring this service to a variety of ED settings with flexibility during times of greater demand. Telemedicine requires both an advanced practice provider to complete the screening and a person on site to provide the necessary support. Certified Nursing Assistants (CNAs) are an efficient and effective member of the healthcare team to provide in-person support while maintaining volume and quality of care. The objective of our project was to leverage telemedicine technology with real-time CNA support to provide emergency medical screenings.</p> <p><strong>Design:</strong> We implemented a quality improvement project. Setting: This project took place in level one urban, academic trauma center with approximately 70,000 patient visits per year and 20 full-time CNAs.</p> <p><strong>Participants/Subjects:</strong> All CNAs were trained in the tele-medicine Clinical Access Station. English-speaking patients, ESI level 3-5 who consented to a telemedicine screening were eligible to participate. Inebriated patients and those with behavioral risks were excluded. Qualitative surveys were distributed to participating patients, providers and CNAs.</p> <p><strong>Methods:</strong> Certified Nursing Assistants underwent a 4 hour training on implementing telemedicine technology. Two nursing educators were responsible for signing-off competency on the medical component of the tasks and a member of the technology team ensured competency on the physical equipment. Telemedicine screening was initiated in April 2016 when an in-person medical screener was not available. Telescreening took place Tuesdays-Fridays 1:00 AM to 3:00 AM, Saturdays and Sundays 7:00AM to 10:00 AM. An additional Friday shift was added in July from 9:00 AM to 5:00 PM. Data collected included number of CNAs trained, number of patients screened, and care quality metrics compared to in-person screening (orders for pain medications, troponins, EKGs and chest x-rays). Patients, providers and CNAs also completed feedback questionnaires regarding satisfaction with the technology.</p> <p><strong>Results/Outcomes:</strong> Since April, 2016 19 CNAs completed telemedicine training and contributed to screening over 5600 patients. Clinical quality metrics varied by type of order, with EKG orders seeing the closest frequency (6.1% difference) and troponin orders the most divergent frequencies (18.9% difference) between in-person and telescreening. Overall, patients, providers and CNAs were satisfied with telescreening (81.6%; 92.3%; 96.7%). Satisfaction was also high with the quality of the audio-visual technology but lower with the use of the integrated medical equipment (eg otoscope, stethoscope). Implications: The changing healthcare environment requires optimization of technology and innovative ways of providing timely patient care. Certified Nursing Assistants are competent and confident in their ability to facilitate telescreening while maintaining quality and quantity of care. Combining the skills of CNAs with tele-medicine advanced practice providers is a high-yield marriage of resources to meet the growing demand for emergency services.</p>