From the 2018 HVPAA National Conference
Daniel Gold (Johns Hopkins School of Medicine), David Newman-toker (Johns Hopkins School of Medicine), Roksolyana Tourkevich (Johns Hopkins School of Medicine), Anthony Brune (Johns Hopkins School of Medicine), Susan Peterson (Johns Hopkins School of Medicine)
Background
A specialized eye exam was shown to be superior to MRI at diagnosing stroke in acute vertigo. Advances in video-oculography have made it possible to record eye movements in the ED, resulting in almost instantaneous remote review, enabling inexpensive, reliable, and rapid tele-diagnosis.
Objectives
Deploy a tele-dizzy VOG-based consultation service to improve diagnosis of emergency department (ED) patients with acute dizziness/vertigo
Methods
Case study of a systems-level quality improvement intervention.
Results
(1) Defined care pathway for evaluating ED patients with dizziness/vertigo of suspected neurologic or peripheral vestibular etiology using portable video-oculography (VOG) in the ED, with urgent clinic referrals for unclear cases. (2) Modeled health system reduction of 50 missed strokes and ~$1 million per year saved on unnecessary imaging and admissions. (3) Conducted training for ED technicians and implemented secure data platforms for eye movement recordings to be electronically transferred for review by clinical faculty using ‘store-forward’ telemedicine approach. Over six months at the pilot hospital site, we assessed 68 tele-dizzy consults, 43 with vestibular diagnoses. The response to the service by ED providers has been positive.
Conclusion
Bringing specialty expertise via tele-dizzy consultation using VOG based rapid triage to EDs is feasible. The next step is testing the hypotheses of improved access, higher quality, and lower costs.
Implications for the Patient
Dizziness and vertigo lead to 4.4 million emergency department (ED) visits annually in the US. Nationally, 1.1 million patients have benign inner ear conditions while 150,000 patients have life threatening strokes. A ‘tele-dizzy’ service could increase quality (through accurate diagnosis) while decreasing waste (test overuse).
