Telemedicine for Triage: Life-saving Now and Efficient in the Future
In optometry, where diagnosis often depends on getting a magnified view through the slit lamp with stains and dyes and using point-of-care tests, telemedicine has limited use in terms of billable visits. But the mechanisms of telemedicine have tremendous value as we continue serving our patients under coronavirus restrictions.
In my practice, we are using a telemedicine approach to triage patients.
Tele-triage is helping us limit nonessential visits while ensuring we do see the patients who need us right away, ensuring they can get the care they need without the risks associated with going to a hospital ER during this pandemic. It’s a process we can continue to use as we reopen.
How Tele-Triage Works
When patients call and a staff member determines they need to talk to a doctor, I call them back and get as much information as possible about their complaint. For example, it is most important to find out whether there has been a noticeable decline in vision. I have patients isolate one eye and then the other eye and ask if they can see clearly or if they notice a change. If a change has occurred, I want to know how long ago it started. I always want to see patients who have a persistent change in vision.
For other patients who have visible problems such as redness or swelling, we jump to FaceTime so I can get a look. Even with FaceTime, the entire tele-triage process only takes about 5 to 10 minutes. We do not charge patients for these triage encounters, choosing instead to only bill for the occasional interaction where we can diagnose a problem and prescribe treatment without seeing the patient in person.
Of course, if a visit is necessary, we utilize all screening measures, ensure social distancing from other patients, and have all parties wear masks. All surfaces within the exam room are wiped down with a strong disinfectant following each encounter.
Immediate Visits and Other Options
During coronavirus restrictions, we have asked a little more than 50% of the tele-triage patients to come into the practice. The most common reason has been decreasing vision accompanied by flashes and floaters, which we suspect may be retinal detachment. We’ve also seen patients for severe red eyes, combined with a history (one or both eyes, duration, pain, discharge, etc.) that does not allow us to rule out bacterial infection or herpes.
When patients have called about red eyes, discomfort and transient vision fluctuation that seem to result from allergies or dry eye disease, we’ve explained that they do not need an office visit at this time. We’ve offered palliative measures and suggested over-the-counter drops, and then talked to the patient again in a few days. A full dry eye workup will be done later.
Swelling and pain could go in a few directions. In most cases, for a bump on the eyelid, we’ve simply recommended application of warm compresses three or four times a day and checked back in a few days. If the swelling spreads, the patient could have preseptal cellulitis and require an antibiotic. If it is a chronic situation, I might bring in the patient and perform IPL (Optima IPL*, Lumenis). If a patient complained of eye swelling, scalp tenderness and jaw claudication, we would order a lab test for temporal arteritis and follow up with the test results to determine if the patient needs a referral to a vascular surgeon.
As we gradually reopen, we will continue to use tele-triage in some capacity, but the percentage of patients we bring into the practice will increase because it will be safe to see them. For example, we will see a surge in cases of ocular irritation and dry eye, including visits for new patients deferred during 6 to 8 weeks of shutdown. For our existing dry eye patient base, we will resume postponed visits and in-office therapies like Optima IPL*, which our patients rely on for management of this chronic, progressive disease.
Factoring in Compassion
We know the relationship between isolation and mental health, and that has made compassion for our patients more important than ever. I recommend seeing patients who are in a distressed, anxious mental state. As we reopen, patients will no doubt feel comforted as normal access to their doctors is restored.
*inflammatory skin conditions such as Rosacea, untreated, can lead to Meibomian Gland Dysfunction. As such, 80% of Rosacea patients are suffering from Meibomian Gland Dysfunction. Optima IPL is used to treat Rosacea, which allows to break the inflammatory process that may lead to Meibomian Gland Dysfunction.