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

## TL;DR

A pilot study explored using home telemonitoring as an alternative to hospital admission for emergency department patients, finding it acceptable if certain safety and support conditions are met.

## Contribution

This study is among the first to investigate patient and professional perspectives on using telemonitoring as an alternative to acute hospital admission from the emergency department.

## Key findings

- Most patients (96.9%) wanted guaranteed hospital admission if telemonitoring failed.
- 11.2% of patients believed telemonitoring could avoid hospital admission if conditions were met.
- Telemonitored patients were satisfied with the system's ease of use and found it reassuring.

## 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.

This pilot study explored whether home telemonitoring could be a safe and acceptable alternative to hospital admission for patients seen in the emergency department (ED). Researchers surveyed 98 medical ED patients and consulted healthcare professionals to assess the feasibility of sending patients home with remote monitoring instead of admitting them to the hospital. Patients saw telemonitoring as a promising option if certain conditions were met. Key factors that made them more comfortable with the idea included guaranteed hospital admission if their condition worsened (96.9%), 24/7 access to their care team (90.8%), and having someone at home to assist them (72.4%). However, some patients were concerned about the severity of their illness, the need for treatments not possible at home, and safety. While 11.2% of patients believed admission could be avoided with telemonitoring, doctors and nurses were slightly more cautious. All patients who actually experienced telemonitoring found it easy to use and reassuring, and recommended this telemonitoring to family and friends. The study concludes that home telemonitoring could be a viable alternative to hospitalization for selected patients if safety and support are ensured. This approach may help reduce hospital crowding while maintaining patient comfort and care quality.