Virtual First Uses Virtual Emergency Medicine Clinicians as a Health System Entry Point: A Cross-Sectional Survey Study.

BACKGROUND: The Coronavirus Disease 2019 (COVID-19) pandemic accelerated utilization and acceptance of telemedicine. Simultaneously, Emergency Departments (ED) have experienced significantly increased ED boarding. With this acceptance of telemedicine and the weighty increase in patient boarding we proposed an innovative Virtual First (VF) program to leverage Emergency Medicine Clinicians' (EMCs) ability to triage patients. VF seeks to reduce unnecessary ED visits by connecting patients with EMCs prior to seeking in-person care rather than utilizing traditional ED referral systems. OBJECTIVE: The goal of this study is to investigate how patients' access to EMCs from home via the establishment of VF changed how patients seek care for acute care needs. METHODS: VF is a synchronous virtual video visit stationed at a tertiary care academic hospital. VF was staffed by EMCs and enabled full management of patient complaints, or if necessary, referral to a primary care physician (PCP), urgent care center (UCC), or ED. Patients self-selected this service as an alternative to seeking in-person care at PCP, UCC or ED. A post-visit convenience sample survey was collected through phone text message or email to VF users. This is a cross- sectional survey study. Primary outcome measure is based on responses to the question, "How would you have sought care if a VF visit was not available to you?" Secondary outcome measures describe valued aspects and criticisms from their visit. Results were analyzed using descriptive statistics. RESULTS: There were 3097 patients seen via VF from July 2021 through May 2022. 176 of 3097 (5.7%) completed the survey. 87 of 176 (49.4%) would have sought care at UCCs if VF had not been available. Twenty-eight (15.9%), twenty-six (14.8%), and one (0.6%) would have sought care at PCPs, EDs, or other locations, respectively. Interestingly, 34 of 176 (19.3%) of patients would not have sought care. The most valued aspects of VF were receiving care in the comfort of home (137 of 176; 77.8%), availability of appointments (105 of 176; 59.6%), not waiting in a lobby (100 of 176; 56.8%), and decreased infectious exposure (89 of 176; 50.6%). For suggested improvements to VF, 58 of 176 (33.0%) patients free-texted "Nothing", 47 (26.7%) suggested connectivity improvements, 23 (13.1%) wanted the ability to have lab work or imaging ordered, 14 (8.0%) had to seek medical care after the VF visit , and desired having a doctor perform a physical exam (5.7%). CONCLUSIONS: VF has potential to restructure how patients seek medical care by connecting EMCs with patients prior to ED arrival. Without the option of VF, 64.2% of patients would have sought care at an acute care facility. VF's innovative employment of EMCs allows for acute care needs to be treated virtually if feasible. If not, EMCs understand the local resources to better direct patients to the appropriate site. This has potential to substantially decrease patient costs because patients are given the appropriate destination for in-person care, reducing the likelihood of the need for transfer and multiple ED visits.

Clinical Characteristics Associated with Return Visits to the Emergency Department after COVID-19 Diagnosis.

INTRODUCTION: Patients diagnosed with coronavirus disease 2019 (COVID-19) require significant healthcare resources. While published research has shown clinical characteristics associated with severe illness from COVID-19, there is limited data focused on the emergency department (ED) discharge population. METHODS: We performed a retrospective chart review of all ED-discharged patients from Wake Forest Baptist Health and Wake Forest Baptist Health Davie Medical Center between April 25-August 9, 2020, who tested positive for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) from a nasopharyngeal swab using real-time reverse transcription polymerase chain reaction (rRT-PCR) tests. We compared the clinical characteristics of patients who were discharged and had return visits within 30 days to those patients who did not return to the ED within 30 days. RESULTS: Our study included 235 adult patients who had an ED-performed SARS-CoV-2 rRT-PCR positive test and were subsequently discharged on their first ED visit. Of these patients, 57 (24.3%) had return visits to the ED within 30 days for symptoms related to COVID-19. Of these 57 patients, on return ED visits 27 were admitted to the hospital and 30 were not admitted. Of the 235 adult patients who were discharged, 11.5% (27) eventually required admission for COVID-19-related symptoms. With 24.3% patients having a return ED visit after a positive SARS-CoV-2 test and 11.5% requiring eventual admission, it is important to understand clinical characteristics associated with return ED visits. We performed multivariate logistic regression analysis of the clinical characteristics with independent association resulting in a return ED visit, which demonstrated the following: diabetes (odds ratio [OR] 2.990, 95% confidence interval [CI, 1.21-7.40, P = 0.0179); transaminitis (OR 8.973, 95% CI, 2.65-30.33, P = 0.004); increased pulse at triage (OR 1.04, 95% CI, 1.02-1.07, P = 0.0002); and myalgia (OR 4.43, 95% CI, 2.03-9.66, P = 0.0002). CONCLUSION: As EDs across the country continue to treat COVID-19 patients, it is important to understand the clinical factors associated with ED return visits related to SARS-CoV-2 infection. We identified key clinical characteristics associated with return ED visits for patients initially diagnosed with SARS-CoV-2 infection: diabetes mellitus; increased pulse at triage; transaminitis; and complaint of myalgias.

Fluctuation of Public Interest in COVID-19 in the United States: Retrospective Analysis of Google Trends Search Data.

BACKGROUND: In the absence of vaccines and established treatments, nonpharmaceutical interventions (NPIs) are fundamental tools to control coronavirus disease (COVID-19) transmission. NPIs require public interest to be successful. In the United States, there is a lack of published research on the factors that influence public interest in COVID-19. Using Google Trends, we examined the US level of public interest in COVID-19 and how it correlated to testing and with other countries. OBJECTIVE: The aim of this study was to determine how public interest in COVID-19 in the United States changed over time and the key factors that drove this change, such as testing. US public interest in COVID-19 was compared to that in countries that have been more successful in their containment and mitigation strategies. METHODS: In this retrospective study, Google Trends was used to analyze the volume of internet searches within the United States relating to COVID-19, focusing on dates between December 31, 2019, and March 24, 2020. The volume of internet searches related to COVID-19 was compared to that in other countries. RESULTS: Throughout January and February 2020, there was limited search interest in COVID-19 within the United States. Interest declined for the first 21 days of February. A similar decline was seen in geographical regions that were later found to be experiencing undetected community transmission in February. Between March 9 and March 12, 2020, there was a rapid rise in search interest. This rise in search interest was positively correlated with the rise of positive tests for SARS-CoV-2 (6.3, 95% CI -2.9 to 9.7; P<.001). Within the United States, it took 52 days for search interest to rise substantially after the first positive case; in countries with more successful outbreak control, search interest rose in less than 15 days. CONCLUSIONS: Containment and mitigation strategies require public interest to be successful. The initial level of COVID-19 public interest in the United States was limited and even decreased during a time when containment and mitigation strategies were being established. A lack of public interest in COVID-19 existed in the United States when containment and mitigation policies were in place. Based on our analysis, it is clear that US policy makers need to develop novel methods of communicating COVID-19 public health initiatives.