Staff opposition thwarts telemedicine success in reducing ED transfers: study –

Telemedicine could be an effective tool in reducing unnecessary emergency department transfers for senior living residents, but obtaining frontline staff member buy-in is key to its success, according to a new research paper.

Researchers at the University of Connecticut looked at the effectiveness of telemedicine intervention services at a California independent living community before the pandemic and found that they have the potential to deter unnecessary emergency department visits. The researchers were unable to demonstrate a clear decrease in emergency department transfers, however, because of telemedicine’s low usage, primarily due to staff opposition.

“Provider buy-in is an ongoing challenge for many organizations implementing telemedicine interventions,” the authors wrote in the Journal of Medical Internet Research. “The views of frontline providers are key to successful implementation of telemedicine interventions.”

Safety staff members in the studied independent living community — most certified as emergency medical technicians — provided 24-hour response to resident calls for assistance. After telemedicine was introduced in 2017, these employees were asked to use it for cases that were not clearly urgent or when they were not sure that transport was warranted. In these situations, staff members were supposed to connect with an emergency medicine physician via a video conference call on a tablet.

Researchers analyzed medical call logs from January 2017 to August 2018 and conducted two resident focus groups and two staff focus groups. Staff perceptions, they found, contributed to the limited use of telemedicine as a triage tool.

The EMT-trained safety staff members said they perceived telemedicine as “time-consuming and as undermining their independent judgment,” said that telemedicine increased their workloads due to difficult-to-navigate software and technical issues, and reported resident reluctance to use telemedicine. 

“Staff highlighted that they were accustomed to making independent triage decisions and that the telemedicine physician ‘asking the same questions’ was not helpful,” the authors wrote.

The workers believed that the program’s goal to deter emergency department visits was the wrong goal and suggested that telemedicine would better address minor medical concerns at the on-site clinic, researchers said. The employees indicated more willingness to use the telemedicine consult if they already had determined that transport was not necessary. 

“The safety staff’s self-description of their role as emergency responders, and the emphasis on telemedicine as potentially more suitable for nonemergency cases, highlights their perception of telemedicine interventions as inappropriate for emergency use,” the authors wrote.

In contrast to staff perceptions, the residents in the focus groups said that using telemedicine had multiple benefits, including avoiding an ambulance transport as well as steering clear of the long wait times, costs and potential health risks of emergency department visits. Although a few residents expressed concerns that telemedicine would delay treatment, the majority of them said they were confident in its use.

Senior living communities wishing to reduce emergency department transports will require a “significant shift in professional mentality and culture” among safety staff, the authors wrote. They suggested education on identifying potentially avoidable transfers and reducing the harm of unnecessary transfers as well as providing opportunities to work and learn with remote physicians.