Categorization of Usage Patterns of an Emergency Department Telehealth Follow-up Program during the COVID-19 Pandemic

Abstract

Research questions: Our overarching questions are: In patients discharged from Texas Health emergency departments, how is the Hospital2Home app-based follow-up program utilized? How has this utilization changed when comparing years immediately pre- and post-the start of the COVID-19 pandemic?

Background, Significance, and rationale for the question: The education that is provided at the time of discharge from the ED is a pivotal moment in a patient’s care. Multiple studies have shown that a large percentage of patients do not understand their discharge instructions. Additionally, many patients don’t keep their follow-up appointments after discharge. Lack of understanding of the discharge instructions and lack of follow-up can lead to unscheduled return visits to the ED and increased hospital costs. A potential solution to help patients better understand their discharge instructions, and mitigate the lack of primary care follow-up and unscheduled return ED visits, is through the use of telehealth for ED follow-up. In 2019, Texas Health Harris Methodist Fort Worth Hospital, a level 2 trauma center with approximately 90,000 visits per year implemented an application-based telehealth follow-up service for ED patients called Hospital to Home (H2H). The program provides all patients who are discharged from the ED with a unique code that can be used with an online or phone application to allow patients to remotely ask a physician questions for 7 days after discharge.

Materials and Methods: A retrospective chart review was conducted to look at characteristics of the utilization of the H2H platform for patients that were seen in the Emergency Department at multiple Texas Health facilities between the period at the beginning of the COVID-19 pandemic, defined as March 2020-March 2021, and the year directly preceding the pandemic, defined as January 2019-January 2020. Characteristics include age, gender, the reason for usage, and secondary outcomes of usage.

Results: Data collection shows a significant increase in usage of the H2H program for the first year of COVID compared to the year immediately prior. There was a significant increase in patients sent for inpatient follow-up by their H2H provider.

Conclusions: This project hopes to shift some of the past approaches that responsibility stops once a patient leaves the ED. Our data shows an increasing number of patients are willing to utilize H2H after discharge. Telehealth can serve as a resource for patients who still may have questions after their discharge and can’t get in to see their primary care physicians. It also can let patients know when they should return to the ED for emergent complications. That way, programs like this can save lives and have benefits for hospital systems nationwide.