Telemonitoring starting in the emergency department as an alternative to acute hospital admission: A prospective pilot study focusing on patient preferences and first experience.

Abstract

Telemonitoring at home may be used to reduce acute hospital admissions via the emergency department (ED), but experience in this setting is scarce. We performed a pilot study to investigate the perspectives and experiences of ED patients and care professionals with telemonitoring, started in the ED and used as potential an alternative to acute hospital admission. In this prospective pilot study, we asked medical ED patients for their perspectives on home monitoring. Suitability for homemonitoring was assessed by ED patients and care professionals. In a subset of patients, we started and evaluated telemonitoring. In total, 98 patients answered a questionnaire. The facilitators for telemonitoring as an alternative to hospital admission were: guaranteed admission if necessary (indicated by 96.9% of patients), possibility to contact the treatment team 24/7 (by 90.8%), and presence of someone to watch over the patient (by 72.4%). Main barriers for telemonitoring as an alternative care form were: need for treatment that could not be provided at home, feeling too severely ill, and judging it unsafe to return home. In total, 11.2% of ED patients indicated that hospital admission could be avoided using telemonitoring, while another 6.1% thought this might be possible. Professionals judged fewer patients capable of being sent home with telemonitoring (physicians: 7.2% and 6.1%, resp.; nurses: 10.4% and 4.2%, resp.). Agreement on the capability of patients to be sent home with telemonitoring between patients and professionals was slight-fair. All telemonitored patients were satisfied with the ease of use and comfort of the system, which gave most patients reassurance and was considered an alternative to admission. In conclusion, telemonitoring at home was seen as an alternative to admission in a substantial proportion of medical ED patients. Facilitators for telemonitoring indicated by patients were guaranteed admission if telemonitoring failed and the possibility to contact the treatment team 24/7, while indicated barriers were related to disease severity and lack of someone to watch over the patient. Telemonitoring in acute care may serve as a potential alternative to admissions if facilitators are met.