For the past year, media has been awash with articles about the difficulty of working in the Emergency Department. Although Covid-19 is the predominant factor effecting the delivery of emergency care, the technological advances in the last few years have been enormously helpful in ensuring providers deliver high quality patient care. Most of these advances allow for easier diagnosis, or easier access to highly advanced technology. This technology can break down barriers to care for patients, not just in the United States, but as well as the rest of the world.
With the Covid-19 pandemic, there has been an obvious concern with healthcare providers being exposed to infected patients and how to mitigate the risk. This is in conflict with the reality that much of the expertise of the Emergency Physician comes from the physical exam of the patient. One of the most ingenious ways to ensure the physical exam can be completed, but the risk is minimized, is with devices such as digital stethoscopes. Placing the device against the patient, but being able to be a safe distance away is a novel approach to using technology as well as ensure the collection of the necessary information. As with most advances, it also allows for collaboration as the data is electronic and can be shared on appropriate platforms with consultants to ensure complete information transmission.
Ultrasound has been used since the 1950’s, mostly for looking at fetuses within the uterus. Now ultrasound can be used to find blood clots in veins, or even detached retinas. It is also very helpful in determining if extremely sick patients need blood transfusions, or even emergent surgery. Emergency Physicians now have the ability to connect the ultrasound probe to a smart phone. Although helpful in the United States, this has been immensely helpful in resource poor countries throughout the world. Given the price point of most of these devices are low enough to allow individuals to purchase the device it allows for individual providers to have access to the information that an ultrasound can provide. This means that even patients in resource poor environments can have the emergency cardiac ultrasounds, or gallbladder ultrasounds to better diagnose emergencies that previously were not accessible to them.
When most people hear about Tele-Health, they think that this applies to a video conference with their primary care physician, but in reality this is a much broader subject. For a number of years, most Emergency Departments have been equipped with video communications with neurologists around the clock. If a patient comes to the Emergency Department with signs of a stroke, there are certain time-sensitive decisions that must be made. As soon as the patient’s symptoms are identified, a neurologist can evaluate the patient via video conference immediately. This ensures appropriate collaboration between the emergency physician and the neurologist early enough in the care to improve the outcomes for the patient.
Advances in technology have also allowed for patients to stay safely at home and still be evaluated by their medical providers. With live video conferencing, patients can connect with their primary care physicians to evaluate all of their medical needs. From blood pressure and diabetes monitoring, even mental health concerns, patients can easily log into their digital device and connect with their doctors or primary care providers. Even more importantly in the midst of a pandemic patients have been able to have the progression of their Covid-19 symptoms monitored while still at home.
One of the biggest risk factors for stroke is an irregular rhythm called atrial fibrillation. In order to safely treat atrial fibrillation in the Emergency Department, the timeframe of the symptoms must be known. With the advent of wearable technology, patients no longer have to come to the Emergency Department to determine if their heart is in atrial fibrillation. The device can either alert the patient or possibly the cardiologist. This has wide ranging implications, but the most important is the reality that most interventions must occur within a certain amount of time from onset of symptoms. Failure to appropriately determine how long the patient has been in atrial fibrillation could possibly risk blood clots being dislodged from the heart and travel to the brain causing a stroke. With the adequate data on the exact duration of symptoms, patients can be treated appropriately with the confidence that side effects have been minimized.
The pandemic has definitely created problems for Emergency Medicine. Even with the various degrees of lockdown across the country due to the pandemic, there have been incredible advances that augment the lives of patients everywhere. Technology will continue to advance, to hopefully improve patients’ lives, and therefore improve outcomes.
Amanda Reed, Director of Operations for Mednow, Spectrum Health There’s tremendous opportunity for mobile health to provide increased support and connections for patients in between doctor appointments, as well as to help them improve their health-related behaviors and health outcomes overall
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