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Telemedicine in the emergency department to decrease personal protective equipment use: a before-and-after study
  1. Bart G J Candel1,
  2. Selma M M Vaes1,
  3. Egid M van Bree2,
  4. Sophie M A Groenen2,
  5. Floor Derkx1,
  6. Lisette A A Mignot1,
  7. Bas de Groot3
  1. 1 Department of Emergency Medicine, Máxima Medical Centre, Veldhoven, Noord-Brabant, The Netherlands
  2. 2 Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Limburg, The Netherlands
  3. 3 Department of Emergency Medicine, Leiden University Medical Centre, Leiden, Zuid-Holland, The Netherlands
  1. Correspondence to Mr Bart G J Candel, Emergency Medicine, Maxima Medical Centre Location Veldhoven, Veldhoven 5504DB, The Netherlands; bartcandel{at}


Background Personal protective equipment (PPE) used by healthcare workers was scarce during the COVID-19 pandemic. The aim of this study was to assess whether telemedicine (using iPads) reduced PPE use in emergency department (ED) patients who were treated in contact isolation, and whether telemedicine had a positive effect on patient anxiety and satisfaction.

Methods We conducted a prospective single centre before-and-after study including ED patients ≥18 years who were treated in contact isolation. PPE use, the Hospital Anxiety Scale and the 15-item Picker Patient Experience Questionnaire were compared between the control period (8 April to 14 April 2020) and intervention period (15 April to 24 April 2020).

Results We included 25 patients in each period. PPE use per patient was higher for physicians in the control period (mean 1.7; 95% CI 1.5 to 1.9) compared with the intervention period (mean 1.2; 95% CI 1.0 to 1.3, p<0.01). Total PPE use per patient contact for ED physicians decreased from 42 out of 42 patient contacts in the control period, to 29 out of 66 patient contacts in the intervention period (difference 54.3%; 95% CI 50.1% to 58.6%, p<0.01). Reported anxiety and satisfaction were not significantly different.

Conclusion PPE use by physicians can successfully be reduced by using telemedicine in the ED without increasing anxiety or dissatisfaction. This study was a first step to gain experience with telemedicine in the ED which has the potential to reduce PPE use in future pandemics or other patients with an indication for contact isolation.

  • infectious diseases
  • viral
  • global health

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  • Handling editor Jo Daniels

  • Contributors BC devised and designed the study and edited the manuscript. SMMV, EMVB and SMAG collected and analysed data, and wrote the manuscript. BdG, FD and LAAM contributed to development of the study protocol and edited the manuscript. All authors have read and approved the manuscript. BC took full responsibility for the study.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the medical ethics committee of the MMC (N20.042).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request. The datasets generated during and analysed during the current study are available from the corresponding author on reasonable request.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.