Impact of a new post-emergency teleconsultation procedure on overcrowding

Abstract

Background Saint Vincent de Paul Hospital is using a post-emergency teleconsultation solution (TELESCOPE). Target patients are discharged early, freeing up examination rooms and hospital beds, and the patient's clinical evolution is monitored by teleconsultation 24 hours after discharge. This study aims to evaluate this pioneering procedure, firstly to assess the impact of TELESCOPE on ED overcrowding, and secondarily to evaluate 72-hour post-emergency hospitalization rates, throughput times, and patient satisfaction. Methods This is a prospective, comparative, before/after type study. The National Emergency Department Overcrowding Scale (NEDOCS) score was used to measure the impact of TLC on ED congestion. It was calculated every hour, every day during the two study periods. The 72-hour post-emergency hospitalization rates were cross-compared for the patients who had a TLC, those who did not have a TLC during the same period, and those from the control period. The patient flow was evaluated by comparing the average length of stay of patients invited to a TLC against those from the control period. The patient’s satisfaction was measured through a telephone survey. Findings The mean difference in NEDOCS score is −3.1 [−4.14; −1.85]. Compared to the control phase, ED spent an additional 160 hours at a ‘normal’ level during the test period. The time spent in the ‘busy’ or ‘overcrowded’ categories was reduced by 129 and 19 hours. There is a significant reduction in the hospitalization rate between teleconsultation patients and all other patients. The patients discharged and invited to a TLC waited 87 minutes longer on average [56 minutes; 119 minutes]. Patient satisfaction is high (91.8%). Interpretation Additional statistical strength would be needed to prove a reduction in overcrowding. The low hospitalization rate reflects adequate recruitment. ED visit times were unexpectedly longer. TELESCOPE seems useful for defining a new type of care. A further multicentre study is scheduled for 2024.