Challenges of Using Instant Communication Technology in the Emergency Department during the COVID-19 Pandemic: A Focus Group Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Setting
2.2. Regionalization within the ED
2.3. Patient Flow and the Diversion Protocol
2.4. The ICT Module
2.5. Focus Group Study
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
ED | Emergency department |
ICT | Instant communication technology |
PCR | polymerase chain reaction |
PPE | personal protection equipment |
TOCC | travel, occupation, contact, and cluster |
Appendix A. The Interview Guide
- Do you have experience on using the ICT to communicate with other people?
- If yes, what are the obstacles on using the ICT?
- What are the major factors influencing the usage of the ICT?
- What are the software and hardware you will use with the ICT to facilitate communications?
- What are the factors that would influence your selection of these software and/or hardware?
- Do you have any experience on using the ICT to communicate with your patience in hospitals?
- If yes, what are the major factors contribute to the usage of the ICT in the field of Emergency Medicine (EM).
- If yes, what are the obstacles on using the ICT in the field of EM.
- If yes, what are the pros and cons of using the ICT in the field of EM during the COVID-19 pandemic?
- Anything you think should be improved to better using the ICT in the field of EM during this pandemic?
- From your perspectives, how does the ICT contribute to the communication between physicians and patients?
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Theme: Setting | |
---|---|
Factors | Considerations |
Patient evaluation | Patient identity should be verified through electronic, paper-based, or virtual registry systems. |
Patients with mild symptoms are suitable for the use of instant communication technology (ICT) in the emergency department (ED). The door-to-patient-evaluation time and the length of ED stay could be reduced. | |
ICT is useful in history taking and general appearance assessment. Emergency physicians were less comfortable performing physical examinations using ICT. Nevertheless, certain physical examinations could be omitted to avoid direct contact. | |
Clinical information could be collected from patient families and caregivers who were restricted from entering the ED due to hospital policy. | |
The use of ICT could be challenging for disabled patients or those who had language barriers. | |
Consultation with subspecialty | ICT is acceptable for certain consultations with subspecialties, especially when the clinical judgment is largely based on verbal discussion, such as history taking or shared decision-making. |
The interpretation of imaging studies is generally acceptable. | |
The visual evaluation of skin lesions is acceptable sometimes. | |
Patient privacy and comfortableness | Shelters or booths may be provided to protect patient privacy. |
The surrounding light should be adjusted to achieve better visualization of the screen image. | |
The environment should be well ventilated, with the temperature and moisture monitored. | |
Sanitation | Non-contact- or motion-activated communication applications should be considered to lessen the risk of contact infection. |
A disposable material for activation of applications on tablets with touch screens could be used. | |
Most tablet computers can be sanitized using 70% isopropyl alcohol wipes. Aerosol sprays, bleaches, abrasives, or direct-spray cleaners are usually unacceptable. Moisture should be kept out of any opening. One of the simplest ways is to place the tablet into a sealed plastic bag and regularly sanitize the outer surface of the bag with medical alcohol. | |
Cost | The potential costs included those for technology teams, hardware, software, Wi-Fi or internet connection, etc. To offset these, the cost of PPE could be significantly reduced. |
The regulations on health insurance reimbursement should be clarified. | |
Registration for and utilization of instant communication applications may have membership fees. | |
Patient acceptability | Patient characteristics may be associated with patient acceptability of telemedicine evaluation. We observed that patients who were younger or were using smartphones were more comfortable receiving ICT evaluation. |
We were unsure whether using instant communication applications, compared with traditional face-to-face interviews, would affect the physician-patient rapport. | |
The familiarity of the ICT evaluation system among working personnel may have an impact on patient acceptability. |
Theme: Hardware | |
---|---|
Factors | Considerations |
Wi-Fi/internet connection | A stable, low-cost, wide-bandwidth, high-quality internet connection is essential. |
Using Wi-Fi, rather than a fixed internet connection mode, is more practical for the mobile setting of instant communication technology (ICT) evaluation. | |
Power | The tablets should have a reasonable sustainable source of power for the high usage of instant communication applications. Power that will last for at least one workload shift (usually 12 h) is ideal. |
Extra power-recharging devices should be available. | |
Image and voice quality | Adequate color presentation, image resolution and size, and voice quality were paramount for patient assessment when using ICT. |
The device should have high-resolution cameras to provide video and image quality. Tablets with built-in front and back cameras were preferred, to enable switching between users. | |
The loudness of the voice should be adjustable to provide adequate audio ability and patient privacy. | |
Public/personal modes | Some health providers may be unwilling to use personal devices as tools for the ICT assessment of emergency patients. A disrupted boundary of professional and personal lives was the major concern. |
Portable/fixed modes | When the zoning or regionalization of the emergency department is well set up, a fixed model of patient assessment using ICT is generally feasible. |
Portable devices may be suitable for discussions for shared decision-making, especially when the emergency department is overcrowded. However, portable devices may require more maintenance since they are vulnerable to frequent usage. | |
Maintenance | The cost and resources needed for maintenance should be preplanned. |
Theme: Software | |
---|---|
Factors | Considerations |
Platform choices | Instant communication applications work on certain platforms; for example, FaceTime is generally for iOS, while LINE is cross-platform. The choice of applications and platforms should be based on the overall design of the telemedicine system that will use instant communication technology (ICT). |
Security | Cybersecurity is important for patient evaluation, so the utilization of ICTs and internet connections should be carefully examined. The risks of personal information breaches were a concern. |
The security upgrades and updates of ICT should be checked regularly. | |
End-to-end encryption may provide better protection of conversations between devices. The content of calls may be retrieved and stored on the servers of ICT applications, so the policies of the ICT software should be clarified. | |
ICT accounts | A single account of emergency department, rather than personal accounts, for each device was preferable. |
Each device may need an individual account for identification. | |
Interview modes | Instant communication applications that support both one-on-one interviews and chat rooms are preferred. Group chatting is useful for consultations that involve multiple subspecialists, team resource management, or patient family meetings for clinical decision-making. |
Video/voice recording | Health insurance reimbursement may require video/voice recording of the patient assessment. |
The recording materials may play an important role when conflicts are encountered, especially medical-legal issues. The accessibility and security control of the storage material should be strictly regulated. | |
The storage of video/voice recording requires significant storage space and cost. | |
Time limitation | Instant communication applications may have time limitations for each call. Extension of the call duration may require additional cost to upgrade the application. |
Time limitations may facilitate the efficiency of patient assessment but should be well communicated between the physician and the patient in advance. |
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Share and Cite
Kuo, Y.-S.; Lu, C.-H.; Chiu, P.-W.; Chang, H.-C.; Lin, Y.-Y.; Huang, S.-P.; Wang, P.-Y.; Chen, C.-J.; Lin, I.-C.; Tang, J.-S.; et al. Challenges of Using Instant Communication Technology in the Emergency Department during the COVID-19 Pandemic: A Focus Group Study. Int. J. Environ. Res. Public Health 2021, 18, 12463. https://doi.org/10.3390/ijerph182312463
Kuo Y-S, Lu C-H, Chiu P-W, Chang H-C, Lin Y-Y, Huang S-P, Wang P-Y, Chen C-J, Lin I-C, Tang J-S, et al. Challenges of Using Instant Communication Technology in the Emergency Department during the COVID-19 Pandemic: A Focus Group Study. International Journal of Environmental Research and Public Health. 2021; 18(23):12463. https://doi.org/10.3390/ijerph182312463
Chicago/Turabian StyleKuo, Yuh-Shin, Chien-Hsin Lu, Po-Wei Chiu, Hung-Chieh Chang, Yu-Yuan Lin, Shao-Peng Huang, Pei-Yu Wang, Cheng-Jen Chen, I-Chen Lin, Jing-Shia Tang, and et al. 2021. "Challenges of Using Instant Communication Technology in the Emergency Department during the COVID-19 Pandemic: A Focus Group Study" International Journal of Environmental Research and Public Health 18, no. 23: 12463. https://doi.org/10.3390/ijerph182312463