Clinical Triaging Considerations for Telehealth

It is primarily imperative to educate stakeholders on ethical principles, the technical aspects, the clinical as well as administrative aspects of tele rehabilitation. This page summarizes the clinical traiging principles.

Patients appropriate for Telehealth

This can be determined from case to case based on a number of factors using

• Clinical judgement
• Patient informed decision making
• Professional standards of care

Triaging

If the patient has access to the available technologies then the following triaging should be considered to determine appropriateness.

●    The patient’s clinical condition or presentation/ diagnosis

●    The severity of the condition, pain, neurological deficits, or severe shortness of breath, how would this impact your decision

●    Potential or actual red flags.

●    The urgency to access care.  Post-operative condition vs non-specific chronic low back pain.

●    Age of patient

●    Presence of other comorbidities or psychological factors

●    Mobility of the patient, physical risk

●    Language barriers

●    Cognition - ability to provide consent and follow instructions

●    What time point of patient care, assessment, review, treatment.  Hybrid model is available, depending on the condition and the patient. 

●    Patient’s physical location.  Their house, friend, GP practice. Geographical location and influence of internet connection barriers. 

●    Who is present during the consult.  Advantage: assistance with tests, or supervision.  Disadvantage: privacy and confidentiality. Privacy of the patient if you need to visualise areas of the patient’s body.  Is it appropriate to ask about certain conditions with someone in the room. 

●    Therapist skill to translate it to telehealth. 

●    Ability to modify tests, ruling out red flags, do you need a local healthcare professional with the patient. 

●    Scope of practice and registration within your state or country

• Reimbursement for telehealth from the patient’s medical insurance or government insurance like medicare.