Perceived Risks, Mitigation Strategies, and Modifiability of Telehealth in Rural and Remote Emergency Departments:...

Area of Science:

• Emergency Medicine
• Telehealth
• Rural Health

Background:

• Telehealth is a rapidly evolving domain in emergency medicine delivery.
• Regional challenges of acute telemedicine delivery remain understudied.
• The WA Country Health Service Emergency Telehealth Service (ETS) has provided virtual care to 87 rural hospitals for 12 years.

Purpose of the Study:

• To explore Emergency Telehealth Service (ETS) clinicians' perceptions of acceptability and appropriateness.
• To understand how clinicians make clinical decisions in rural and remote emergency telemedicine settings.
• To examine risk assessment and mitigation strategies in virtual emergency care.

Main Methods:

• Qualitative study utilizing semistructured interviews with ETS clinicians.
• Exploration of factors influencing clinical decision-making in emergency telemedicine.
• Comparison of emerging themes with medical board and college guidelines.

Main Results:

• Accurate clinical decisions, particularly patient disposition, are crucial for effective virtual care.
• A mutual learning model improved timeliness and accuracy, with improvisation addressing technological barriers.
• Nonmodifiable risks included patient condition, urgency, ED capability, clinician scope, and transfer distances.

Conclusions:

• Emergency telehealth can improve clinical decision-making in rural emergency departments.
• ETS clinicians can ensure patient safety by integrating local hospital and community contexts.
• Further research is needed on the impact of telehealth on regional emergency medicine scope and skills.