Using Telemedicine to Optimize Teamwork and Infection Control of Critical and Highly-infectious Patients in an Emergency Department

Application of Telemedicine to Optimize Teamwork and Infection Control of Critical Patients in Isolation Rooms in the Emergency Department During Novel Coronavirus Disease 2019 Outbreak

Since 2000, various emerging infectious diseases have repeatedly caused serious impact on the health of the global population and the healthcare systems. With the growing international transportation and improving accessibility of the healthcare systems, hospitals have been inevitably the first sentinels dealing with emerging infectious diseases. The biological disasters, such as the Severe Acute Respiratory Syndrome (SARS) in 2003, the Middle East Respiratory Syndrome (MERS) outbreak in South Korean in 2015, and the Coronavirus disease 2019 (COVID-19) outbreak this year, challenged our vulnerable healthcare systems and caused great loss of lives.

Regarding the ongoing global epidemics and possible community outbreaks of the COVID-19, the management of biological disasters for an overcrowded emergency department should be planned. In the early 2020, the emergency department used a double-triage and telemedicine method to treat non-critical patient with suspected COVID-19. This application reduced the exposure time of the first responders and reserve adequate interview quality. However, for the critical patients treated in the isolated resuscitation rooms, the unique environment limited the teamwork and communication for the resuscitation team. These factors might led to poorer quality of critical care.

The investigators designed a telemedicine-teamwork model, which connected the isolation room, prepare room and nursing station by an video-conferencing system in the emergency department. This model try to break the barriers of space between the rooms and facilitate the teamwork communications between each unit. Besides, by providing a more efficient workflow, this model could lower the total exposure time for all workers in the contaminated area. This study was conducted to evaluate the benefits of the telemedicine-teamwork model and provide a practical, safe and effective alternative to critical care of the patients with suspected highly infectious diseases.

Study Overview

• Status: Completed
• Conditions: Critical Illness; Telemedicine; Emergency Service, Hospital; Infections, Respiratory
• Intervention / Treatment: Other: telemedicine; Other: traditional communication tools

• Study Type: Observational
• Enrollment (Actual): 74

Contacts and Locations

• Study Contact: Name: Chien-Hao Lin, MD; Phone Number: 62831 +88623123456; Email: houdaix@gmail.com

Study Locations

• Taiwan
  • Taipei, Taiwan, 100
    • National Taiwan University Hospital
    • Contact: Chien-Hao Lin, MD; Phone Number: 62831 +88623123456; Email: houdaix@gmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 20 years to 99 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Patients triaged as highly-infectious patients, needed to be treated in isolation rooms in the emergency department.

Description

For patients:

1.Patients triaged as highly-infectious patients, needed to be treated in isolation rooms in the emergency department.

For healthcare providers:

1. Those providers who participates in the critical care for the patients included in the study accordingly

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Critical patients in the emergency department	Other: telemedicine; Using telemedicine system to communicate; Other: traditional communication tools; Use telephone or direct verbal communication

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
time to complete intubation	immediately after intervention

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
teamwork score	Team Emergency Assessment Measure, minimal score is 0 and the maximal score is 4. Higher score means a better outcome.	immediately after intervention
exposure time in isolation rooms		immediately after intervention

Collaborators and Investigators

• Sponsor: National Taiwan University Hospital
• Investigators: Principal Investigator: Chien-Hao Lin, MD, National Taiwan University Hospital

Publications and helpful links

General Publications

• Lin CH, Lin HY, Wu SN, Tseng WP, Chen WT, Tien YT, Wu CY, Huang CH, Tsai MS. Using a telemedicine-assisted airway model to improve the communication and teamwork of tracheal intubation during the coronavirus disease 2019 pandemic. J Telemed Telecare. 2022 Sep 6:1357633X221124175. doi: 10.1177/1357633X221124175. Online ahead of print.

Study record dates

Study Major Dates

• Study Start (Actual): February 3, 2021
• Primary Completion (Actual): July 31, 2021
• Study Completion (Actual): July 31, 2021

Study Registration Dates

• First Submitted: September 23, 2020
• First Submitted That Met QC Criteria: October 12, 2020
• First Posted (Actual): October 19, 2020

Study Record Updates

• Last Update Posted (Actual): May 17, 2023
• Last Update Submitted That Met QC Criteria: May 15, 2023
• Last Verified: October 1, 2020

More Information

Terms related to this study

• Keywords: critical care; COVID-19; telemedicine; emergency medicine; isolation
• Additional Relevant MeSH Terms: Pathologic Processes; Respiratory Tract Diseases; Disease Attributes; Emergencies; Infections; Communicable Diseases; Critical Illness; Respiratory Tract Infections
• Other Study ID Numbers: 202007114RINA