45 Impact of Telemedicine on Care Delivery for Patients With Chest Pain in the Emergency Department

Study Objectives: The outbreak of the COVID-19 pandemic has led to the rapid adoption of novel telemedicine programs within the emergency department (ED) to minimize provider exposure and conserve personal protective equipment (PPE). In this study, we sought to assess how the adoption of telemedicine in the ED impacted both the timeliness of interventions and the order patterns for patients with chest pain. Methods: A single-center, retrospective, propensity score matched study was designed for patients presenting with chest pain (n = 1608). The study period was defined between April 1st, 2020, and September 30th, 2020. Patients who received telemedicine were propensity score matched based on age, sex, ED disposition, insurance status, and evaluation/management level to patients who did not receive telemedicine. Three specific time-based quality metrics were compared for all ECG, troponin I, and aspirin orders within the two groups: arrival to order and arrival to result (or administration for aspirin). In addition, the frequency of the five most frequent lab, imaging, and medication orders were compared. Results: 455 patients who received telemedicine were matched to 455 similar patients without telemedicine with standardized mean difference < 0.1 for all matched covariates. Telemedicine was associated with longer time to first ECG (5.0 minutes for controls, 8.0 minutes for telemedicine cohort, p-value <0.001), time to ECG result (12 minutes vs 18 minutes, p-value <0.001), and time to troponin result (104 minutes vs 123 minutes, p-value < 0.001). Generally, while patients receiving telemedicine had more tests ordered compared to controls, no group received a statistically significant higher proportion of lab, imaging, or medication orders compared to the controls. Conclusions: For patients presented with chest pain in the ED, there were small but significant differences in time-based metrics (door-to-ECG, time-to-troponin) between telemedicine and controls. While the effect size of these differences is small, it is known that increased door-to-ECG times are associated with slower downstream intervention such as door-to-balloon time. Based on analysis of laboratory, imaging, and medication order patterns, telemedicine does not appear to significantly affect the clinical workup patients received. This study is an important objective assessment of the impact that telemedicine has upon the quality of care delivered to patients and can guide future telemedicine implementation after the COVID-19 pandemic. [Formula presented]