EP-102 - Telemedicine-guided Strategy for Dengue Fever Outbreaks in Brazil: An Effective Solution
Sunday, April 29
4:25 PM - 4:40 PM
Location: Education Zone, Booth 2416, Screen 1
Dengue fever is a major public health concern in Brazil and in other tropical developing countries. Summertime dengue outbreaks carry a major burden for emergency health services. In 2015, a major outbreak took place, with more than 746.000 confirmed cases and 229 deaths between January and May, marking a 234% increase in Dengue cases and a 45% increase in deaths comparing with previous year. Therefore, Brazil endured one of the biggest dengue fever epidemics of its history in 2015, with public and private health services struggling, overloaded with record number of cases.
In order to deal with a great number of patients seeking emergency care for suspected dengue fever, many hospitals, especially public ones, set up especial tents for dealing with massive patient overflow. Patients were referred to those "Dengue tents" mostly from primary care units. The routine procedure consisted of an initial screening performed by registered nurses, including vital signs (temperature, blood pressure, heart rate, and respiratory rate), and blood sampling for platelet count, hematocrit and a point-of-care dengue-specific diagnostic test (NS1 antigen testing).
There is no specific treatment for dengue fever. Intravenous or intensive oral hydration and clinical support therapies are the mainstream of treatment. Brazilian Ministry of Health defined specific guidelines for risk classification and treatment, which were precisely followed. After initial screening and blood testing, patients were classified by potential risk of complications, oral or intravenous hydration were prescribed and patients were then referred for a live video visit or traditional consultation with a medical doctor, following a simple queue. The physician was responsible for deciding between discharge, outpatient treatment or hospitalization.
Between April and May 2015, over 2900 patients attended our Telemedicine-assisted "Dengue tent", located at the parking lot of a primary-care health facility in a remote area of São Paulo. During working hours, there were ten doctors available onsite and one at a distance, available through real-time videoconference. More than 2000 patients (67%) received the diagnosis of Dengue fever, 272 (13,6%) of which evaluated by a real-time video consultation. 256 (94,1%) were immediately discharged and only 16 cases (5,9%) were referred to traditional care, additional intravenous hydration or hospital admission.
In conclusion, our experience shows that in a resource poor environment facing an overflow of patients due to a dengue fever outbreak, a telemedicine-guided strategy within a "Dengue Tent" can be an effective solution to optimize patient flow and staff allocation. There is a potential cost reduction and an achievable 94,1% resolution rate without compromising quality of care.
- Understand and define use of telemedicine in a crisis situation, such as a dengue fever outbreak.
- Conduct a telemedicine-guided strategy for optimal risk classification and treatment decision in high demand for emergency service situations.
- Assess the results of a telemedicine-guided strategy designed to deal with a major infectious disease outbreak in a resource-poor environment