Users

There are three primary user groups interacting with this system, and each one has a very different perspective and interaction with the system.

Patient

Patients using this process have come to the Emergency Department but are experiencing mild enough symptoms to warrant a teletriage visit instead of an in-person triage.





ED Nurse or Tech

The introduction of teletriage introduces a new role for nurses and techs, in which they are responsible for taking the patient to the teletriage room, taking their vitals, and setting up the telehealth call.

Provider

The teletriage physician is an ED physician that would normally be stationed in one Emergency Department. Through teletriage, the physician is capable of triaging patients at multiple hospitals at once from a remote location.

Environments

Two users, the patient and nurse or tech participate from the emergency department, while the physician interacts from a remote office. Each user also has unique hardware and interfaces.

Patient

• Emergency Department

  • Intake room

  • Teletriage room

  • Fast track or ED bed

• 1 tablet, Jabra speaker, and movable camera for patient EmOpti video calls

ED Nurse or Tech

• Teletriage room in Emergency Department

• 1 monitor for EPIC and EmOpti patient queue

Provider

• Private Office

• 3 monitors - 1 for EmOpti, 1 for Center City ED Trackboard, 1 for Methodist ED Trackboard

  • All providers interviewed choose to use only 2 monitors.

• Computer camera

Issues

While simple and easy to use, the existing system had many opportunities for improvement through user forgiveness and increased information, more automated processes, more connected systems, and a hardware-agnostic platform.

• On the Patient cards in provider queue the list location and chief complaint are difficult to read and have lead to the following issues:

  • None of the providers interviewed acknowledged that a chief complaint is shown and went so far as to request adding that feature.

  • Lack of prominence of these can make it difficult for providers to pull up the right patient when there are common names. This has lead to some teletriage providers to start charting on the wrong patient’s chart, requiring them to exit the chart without saving and redo all of their work in the correct patient’s chart

• Providers can get overwhelmed and stressed when calls are back to back or piling up in queue.

• “There’s too many clicks.” “It requires a lot of clicking.”

  • Provider has to toggle back and forth between ED trackboards— adding time to their workflows and increasing stress.

  • Increases risk of provider opening the wrong patient chart.

• Can’t open a call back up if ended accidentally or due to a technical issue.

• At times, the system will kick people off in the middle of a call.

• Patients can be unsure of the teletriage process. Training emphasizes need to set patients’ expectations and make sure they understand the process, and completely relies on staff and providers doing so.

• Providers are responsible for knowing or finding the contact information for each Emergency Department and other necessary departments and physicians, which may change and are difficult to keep track of.

• EmOpti specifically requires Jabra speakers for ED side making it more difficult to provide the necessary hardware.

Provider Side

• Provider side connects to EPIC.

  • Allow more information pulled into patient queue cards from EPIC to reduce double work.

• Make location and chief complaint more visible on patient cards in queue screen.

• List contact number for the relevant patient location in patient queue tile, in case of technical issue.

• Keep a history/log of patient calls on provider side in case provider accidentally ends a call too soon, is kicked off of a call due to system failure, or didn’t have a chance to put in EPIC orders.

• Consider having a small, floating, movable video feed over EPIC chart, along with the larger image on the telehealth call screen.

• Auto-logout after a certain amount of time of inactivity.

ED Side

• ED side connects to EPIC.

• Nurse or Tech’s teletriage screen should show how many patients are in queue for a telehealth consult, along with estimated wait time, to help them manage expectations and make decisions.

• Help care teams to set and maintain patient expectations by listing steps of tele-triage process on tele-triage tablet as holding/inactive screen.

• Visual and audio cues on patient-facing screen that indicate the provider is joining the call.

• Have a nice sign off screen (text that thanks patients for using telehealth) for patients.

  • This text can reinforce that they will see another provider in person.

Provider Side

• Change patient queue to show all patients that go through the ED (like a teletriage trackboard).

  • At top of patient queue, allow physicians to select which ED locations they are working in (necessary for scaling to more hospitals).

  • Patient status updates as they move towards teletriage consult.

  • Visual and audio cues indicate when the patient is ready for teletriage.

  • Patients who do not need to be teletriaged leave the queue.

• Add button to patient card in queue that automatically opens their chart in EPIC, ideally onto the medical history page, eliminating the need to switch trackboards and search for patients.

ED Side

• No requirements for the ED were deemed complicated enough to be delayed until Version 2.

Provider side

• 2 monitors: 1 for EPIC (trackboards will change automatically), 1 for Teletriage calls

• Webcam that can be moved to preferred monitor

• Ability to fit Teletriage application and EPIC on one screen to allow for work from home

ED side

• Tablet with speaker and microphone

• Movable web cam