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Sassi K, Tardif E, Lasry L, Manenc L, Guerby P, Minville V. Assessing feasibility and satisfaction in third-trimester pre-anaesthetic teleconsultations: A prospective observational study. Indian J Anaesth 2024; 68:183-188. [PMID: 38435660 PMCID: PMC10903770 DOI: 10.4103/ija.ija_721_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/20/2023] [Accepted: 12/03/2023] [Indexed: 03/05/2024] Open
Abstract
Background and Aims Pregnancy presents risks, particularly for women with pre-existing health problems. Pre-anaesthetic consultations can help anticipate these risks and establish a medical management strategy on the delivery day. While teleconsultations gained popularity during the coronavirus disease 2019 (COVID-19) pandemic, research on pre-anaesthetic teleconsultations during pregnancy is limited. This study aimed to assess patient satisfaction and physician perception of teleconsultations for third-trimester pre-anaesthetic consultations. Methods A prospective observational study included pregnant women who opted for teleconsultations for pre-anaesthetic consultations. Patient satisfaction was assessed using Likert scale questions and the System Use Scale. Anaesthetist satisfaction was evaluated using a Likert scale and by considering changes in anaesthetic techniques and missing clinical data in the pre-anaesthetic assessment. Data analysis utilised SPSS Statistics for Windows, Version 20.0. encompassing descriptive statistics, hypothesis testing and odds ratio calculations. This approach explored the correlation between patient and anaesthetist satisfaction and pertinent risk factors. Results The study enroled 99 patients, with 85% expressing satisfaction and high satisfaction on the Likert scale and 88% finding the teleconsultation acceptable based on the System Use Scale (score ≥ 70). Anaesthetists reported being satisfied with the pre-anaesthetic consultations in 94% of cases. Conclusion This study demonstrates the feasibility and effectiveness of telemedicine consultations in obstetric anaesthesia, showing high patient and anaesthetist satisfaction rates.
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Affiliation(s)
- Kaissar Sassi
- Department of Anaesthesia, Centre Hospitalier Universitaire de Purpan, Toulouse, France
| | - Elsa Tardif
- Department of Anaesthesia, Centre Hospitalier Universitaire de Purpan, Toulouse, France
| | - Louis Lasry
- Department of Anaesthesia, Centre Hospitalier Universitaire de Purpan, Toulouse, France
| | - Lola Manenc
- Department of Anaesthesia, Centre Hospitalier Universitaire de Purpan, Toulouse, France
| | - Paul Guerby
- Department of Anaesthesia, Centre Hospitalier Universitaire de Purpan, Toulouse, France
| | - Vincent Minville
- Department of Anaesthesia, Centre Hospitalier Universitaire de Purpan, Toulouse, France
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Tomás AS, Dias RM, Cabido H, Nunes C, Lemos P. Online Group Consultation on Labor Analgesia for Pregnant Women: Is It Feasible? Cureus 2024; 16:e51687. [PMID: 38313986 PMCID: PMC10838392 DOI: 10.7759/cureus.51687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2024] [Indexed: 02/06/2024] Open
Abstract
INTRODUCTION Our department of anesthesiology has been conducting weekly, for several years, a group consultation to educate childbearing people about labor analgesia. The emergence of the COVID-19 pandemic forced an adaptation to a virtual consultation format. Since there are no studies about online group consultation on labor analgesia in order to understand its role, an anonymous questionnaire was created and applied. The objective was to evaluate this new consultation format, namely the ease of access, usefulness of the content provided, and its impact on the satisfaction and experience of childbirth. MATERIALS AND METHODS An observational prospective study was conducted. A questionnaire was sent by e-mail after childbirth to all childbearing people participating in the online consultation from January 20, 2021, to March 2, 2022. SPSS Statistics version 28.0 (IBM Corp. Released 2021. IBM SPSS Statistics for Windows, Version 28.0. Armonk, NY: IBM Corp) was used for statistical analysis. Internal consistency was analyzed using Cronbach's alpha. RESULTS A total of 563 participants were eligible, and 404 (71.8%) completed questionnaires were analyzed. A few technical problems were reported. The participants considered their privacy respected, and more than 90% were satisfied with the content of the online consultation, the opportunity to pose questions, and the help managing expectations. Considering face-to-face consultation, 89.6% of patients considered the online format an effective alternative, 63.2% believed it could replace the old model, and 96.3% would recommend it. CONCLUSIONS Our study demonstrates that online consultation on labor analgesia was a good strategy during the COVID-19 pandemic and has the potential to be used in this format in the future.
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Affiliation(s)
- Ana Sofia Tomás
- Department of Anaesthesiology, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - Raquel M Dias
- Department of Anaesthesiology, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - Hermina Cabido
- Department of Anaesthesiology, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - Catarina Nunes
- Department of Science and Technology, Universidade Aberta, Lisboa, PRT
| | - Paulo Lemos
- Department of Anaesthesiology, Centro Hospitalar Universitário de Santo António, Porto, PRT
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Popivanov P, Bampoe S, Tan T, Rafferty P. Development, implementation and evaluation of high-quality virtual preoperative anaesthetic assessment during COVID-19 and beyond: a quality improvement report. BMJ Open Qual 2022; 11:bmjoq-2022-001959. [PMID: 36216375 PMCID: PMC9556744 DOI: 10.1136/bmjoq-2022-001959] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Preoperative risk factor identification and optimisation are widely accepted as the gold standard of care for elective surgery and are essential for reducing morbidity and mortality. COVID-19 public health restrictions required a careful balance between ensuring best medical practices and maintaining safety by minimising patient face-to-face attendance in the hospital. Based on the successful implementation of telemedicine (TM) in other medical specialties and its feasibility in the preoperative context, this study aimed to develop, implement and evaluate a high-quality virtual preoperative anaesthetic assessment process. METHODS The three-step model for improvement was used. The specific, measurable, actionable, relevant, time aim (step 1) and measures for improvement (step 2) were defined at the onset of the project. The plan-do-study-act tool was used for the structured implementation of improvement interventions (step 3) in three phases. Data relating to virtual and in-person referrals, assessments, did-not-attend (DNA) rate, consultation time, day of surgery delays and cancellations, and service-user and provider experience surveys were recorded prospectively. RESULTS A total of 2805 patients were assessed in the preoperative anaesthetic assessment clinic between July 2020 and March 2021. The mean rate of virtual preoperative assessments was 50% (SD ±10) (1390/2805). 0.1% (30/2805) were inappropriately referred on the alternative pathway. The DNA rate was 0.4% (8/1398) and 3% (43/1458) for virtual and in-person pathways, respectively. The mean consultation times for virtual and in-person attendance were 19 (SD ±7) and 31 (SD ±13) min, respectively. There were five same-day surgery cancellations and one delay due to medical reasons. When asked about their experience with the virtual assessment, both service users and providers reported high satisfaction, minimal technical difficulties and shared concerns about limited opportunities for physical examination. CONCLUSION This is one of the first implementational studies to comprehensively outline the feasibility of TM in preoperative anaesthetic assessment during COVID-19.
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Affiliation(s)
- Petar Popivanov
- Department of Perioperative Medicine, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Sohail Bampoe
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Terry Tan
- Department of Perioperative Medicine, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Paul Rafferty
- Faculty of Leadership and Quality in Healthcare, Royal College of Physicians of Ireland, Dublin, Ireland
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Burrell A, Zrubka Z, Champion A, Zah V, Vinuesa L, Holtorf AP, Di Bidino R, Earla JR, Entwistle J, Boltyenkov AT, Braileanu G, Kolasa K, Roydhouse J, Asche C. How Useful Are Digital Health Terms for Outcomes Research? An ISPOR Special Interest Group Report. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:1469-1479. [PMID: 36049797 DOI: 10.1016/j.jval.2022.04.1730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 03/09/2022] [Accepted: 04/15/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES This study aimed to review definitions of digital health and understand their relevance for health outcomes research. Four umbrella terms (digital health, electronic health, mobile health, and telehealth/telemedicine) were summarized in this article. METHODS PubMed/MEDLINE, Embase, Cochrane Library, and EconLit were searched from January 2015 to May 2020 for systematic reviews containing key Medical Subject Headings terms for digital health (n = 38) and synonyms of "definition." Independent pairs of reviewers performed each stage of the review, with reconciliation by a third reviewer if required. A single reviewer consolidated each definition for consistency. We performed text analysis via word clouds and computed document frequency-and inverse corpus frequency scores. RESULTS The search retrieved 2610 records with 545 articles (20.9%) taken forward for full-text review. Of these, 39.3% (214 of 545) were eligible for data extraction, of which 134 full-text articles were retained for this analysis containing 142 unique definitions of umbrella terms (digital health [n = 4], electronic health [n = 36], mobile health [n = 50], and telehealth/telemedicine [n = 52]). Seminal definitions exist but have increasingly been adapted over time and new definitions were created. Nevertheless, the most characteristic words extracted from the definitions via the text analyses still showed considerable overlap between the 4 umbrella terms. CONCLUSIONS To focus evidence summaries for outcomes research purposes, umbrella terms should be accompanied by Medical Subject Headings terms reflecting population, intervention, comparator, outcome, timing, and setting. Ultimately a functional classification system is needed to create standardized terminology for digital health interventions denoting the domains of patient-level effects and outcomes.
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Affiliation(s)
| | - Zsombor Zrubka
- Health Economics Research Center, University Research and Innovation Center, Óbuda University, Budapest, Hungary; Corvinus Institute for Advanced Studies, Corvinus University of Budapest, Budapest, Hungary
| | | | - Vladimir Zah
- HEOR, Z Rx Outcomes Research Inc, Mississauga, ON, Canada
| | | | | | - Rosella Di Bidino
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | | | | | - George Braileanu
- National Institute for Health and Care Excellence, Manchester, England, UK
| | - Katarzyna Kolasa
- Health Economics and Healthcare Management, Kozminski University, Warszawa, Poland
| | - Jessica Roydhouse
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Carl Asche
- University of Illinois College of Medicine, Chicago, IL, USA
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Kjaer K. Quality Assurance and Quality Improvement in the Labor and Delivery Setting. Anesthesiol Clin 2021; 39:613-630. [PMID: 34776100 DOI: 10.1016/j.anclin.2021.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Quality assurance (QA) is the maintenance of a desired level of quality, whereas quality improvement (QI) is the continuous process of creating systems to make things better. Implementation science promotes the systematic uptake of best practices. Bundles are a structured list of best practices whereas toolkits provide the necessary details, rationale, and implementation materials, such as sample policies and protocols. Metrics that can guide care on the labor and delivery (L&D) floor may be related to team structure (obstetric, multidisciplinary, anesthetic), processes (patient monitoring, team effects), and outcomes (postpartum hemorrhage, venous thromboembolism). Multiple anesthetic quality metrics have been proposed, including the mode of anesthesia for cesarean delivery.
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Affiliation(s)
- Klaus Kjaer
- Weill Cornell Medical College, 525 East 68th Street, New York, NY 10065, USA.
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Benhamou D, Miled R, Corsia G, Horlin AL, Kantor E, Legouez A, Medioni P. Antenatal telehealth for anaesthesia consultations at the time of lockdown during the first COVID-19 wave in Paris ✰. J Gynecol Obstet Hum Reprod 2021; 51:102238. [PMID: 34607078 PMCID: PMC8485714 DOI: 10.1016/j.jogoh.2021.102238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 09/29/2021] [Indexed: 12/03/2022]
Affiliation(s)
- Dan Benhamou
- Service d'Anesthésie Réanimation Médecine Péri Opératoire, AP-HP. Université Paris Saclay, Hôpital Bicêtre - 78, rue du Général Leclerc, 94275 Le Kremlin Bicêtre Cedex, France.
| | - Rania Miled
- Service d'Anesthésie Réanimation Médecine Péri Opératoire, Centre hospitalier intercommunal de Villeneuve Saint-Georges, France
| | - Gerard Corsia
- Service d'Anesthésie Réanimation Médecine Péri Opératoire, AP-HP, Hôpital Pitié Salpétrière, Paris, France
| | - Anne-Laure Horlin
- Service d'Anesthésie Réanimation Médecine Péri Opératoire, AP-HP, Hôpital Robert Debré, Paris, France
| | - Elie Kantor
- Service d'Anesthésie Réanimation Médecine Péri Opératoire, AP-HP, Hôpital Bichat, Paris, France
| | - Agnès Legouez
- Service d'Anesthésie Réanimation Médecine Péri Opératoire, AP-HP, Hôpital Antoine Béclère, Paris, France
| | - Patricia Medioni
- Service d'Anesthésie Réanimation Médecine Péri Opératoire, Centre hospitalier intercommunal de Villeneuve Saint-Georges, France
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Denomme J, McCarroll K, Prabhakar C, Petrar S. Videoconferencing as a tool to improve access to regional anesthesia in remote community hospitals. Can J Anaesth 2021; 68:1836-1837. [PMID: 34498232 DOI: 10.1007/s12630-021-02097-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/22/2021] [Accepted: 08/23/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Justine Denomme
- Department of Anesthesia, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, Canada.
| | - Kirk McCarroll
- Department of Anesthesia, Queen Victoria Hospital, Revelstoke, BC, Canada
| | - Chris Prabhakar
- Department of Anesthesia, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, Canada
| | - Steven Petrar
- Department of Anesthesia, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, Canada
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Gitterman A, Klaus J, Williams K, Murphy J. Peripartum optimization and coordination of collaborative care practice: a critical role for the obstetric anesthesiologist in combating maternal morbidity and mortality. Curr Opin Anaesthesiol 2021; 34:205-211. [PMID: 33935167 DOI: 10.1097/aco.0000000000000984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Antenatal anesthesia clinics remain uncommon despite the rising incidence of maternal morbidity and mortality in the United States. The purpose of the present review is to outline the major considerations and challenges surrounding antenatal anesthetic evaluation. RECENT FINDINGS Data from the general surgical population would suggest a mortality benefit associated with preoperative anesthesia evaluation, although no such data exists in the obstetric population.Robust systems for case ascertainment and referral are needed. Recent publications on obstetric comorbidity indices may provide useful tools to ascertain high-risk parturients for a referral to antenatal obstetric anesthesiology clinics and higher levels of maternal care. Major obstetric organizations have identified and laid out criteria for maternal level of care. Anesthesiology resources also play a role in these designations and can help triage patients to facilities with appropriate resources. SUMMARY Obstetric anesthesiologists have a critical role not only in preoperative patient optimization but also in coordinating multidisciplinary care for optimal patient outcomes.
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Affiliation(s)
- Anna Gitterman
- Johns Hopkins Hospital, Department of Anesthesiology and Critical Care Medicine, Baltimore, Maryland, USA
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Ceruti C, Carry PY, Ferrier C, Friggeri A, Piriou V. [Telehealth in peroperative medicine]. ACTA ACUST UNITED AC 2020; 24:243-249. [PMID: 32963474 PMCID: PMC7498471 DOI: 10.1016/j.pratan.2020.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
La télémédecine est en plein essor dans tous les domaines médicaux. En plus d’être l’une des priorités de l’OMS afin de répondre aux problèmes des coûts et de l’accessibilité à des soins de qualité, que ce soit dans les pays développés ou en voie de développement, la crise sanitaire récente liée au COVID-19 a montré qu’elle pouvait être un atout certain pour la permanence des soins en situation de crise. Si la télémédecine en anesthésie se développe pour l’ensemble de la prise en charge péri-opératoire des patients, cette mise au point vise à présenter les données récentes de la littérature concernant la place de la télémédecine en anesthésie pour l’évaluation pré-opératoire. Quatre points principaux sont abordés : (1) l’éligibilité et la faisabilité de la téléconsultation d’anesthésie; (2) son efficacité en terme de temps passé en consultation d’anesthésie, taux d’annulation d’intervention et concordance de l’examen physique; (3) la satisfaction des patients, et enfin; (4) son potentiel impact économique.
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Affiliation(s)
- Charlotte Ceruti
- Service d'anesthésie réanimation, centre hospitalier Lyon-Sud, hospices civils de Lyon, université Claude-Bernard-Lyon-1, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France
| | - Pierre Yves Carry
- Service d'anesthésie réanimation, centre hospitalier Lyon-Sud, hospices civils de Lyon, université Claude-Bernard-Lyon-1, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France
| | - Clémence Ferrier
- Service d'anesthésie réanimation, centre hospitalier Lyon-Sud, hospices civils de Lyon, université Claude-Bernard-Lyon-1, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France
| | - Arnaud Friggeri
- Service d'anesthésie réanimation, centre hospitalier Lyon-Sud, hospices civils de Lyon, université Claude-Bernard-Lyon-1, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France
| | - Vincent Piriou
- Service d'anesthésie réanimation, centre hospitalier Lyon-Sud, hospices civils de Lyon, université Claude-Bernard-Lyon-1, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France
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Puro NA, Feyereisen S. Telehealth Availability in US Hospitals in the Face of the COVID-19 Pandemic. J Rural Health 2020; 36:577-583. [PMID: 32603017 PMCID: PMC7362065 DOI: 10.1111/jrh.12482] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Telehealth is likely to play a crucial role in treating COVID-19 patients. However, not all US hospitals possess telehealth capabilities. This brief report was designed to explore US hospitals' readiness with respect to telehealth availability. We hope to gain deeper insight into the factors affecting possession of these valuable capabilities, and how this varies between rural and urban areas. METHODS Based on 2017 data from the American Hospital Association survey, Area Health Resource Files and Medicare cost reports, we used logistic regression models to identify predictors of telehealth and eICU capabilities in US hospitals. RESULTS We found that larger hospitals (OR(telehealth) = 1.013; P < .01) and system members (OR(telehealth) = 1.55; P < .01) (OR(eICU) = 1.65; P < .01) had higher odds of possessing telehealth and eICU capabilities. We also found evidence suggesting that telehealth and eICU capabilities are concentrated in particular regions; the West North Central region was the most likely to possess capabilities, given that these hospitals had higher odds of possessing telehealth (OR = 1.49; P < .10) and eICU capabilities (OR = 2.15; P < .05). Rural hospitals had higher odds of possessing telehealth capabilities as compared to their urban counterparts, although this relationship was marginally significant (OR = 1.34, P < .10). CONCLUSIONS US hospitals vary in their preparation to use telehealth to aid in the COVID-19 battle, among other issues. Hospitals' odds of possessing the capability to provide such services vary largely by region; overall, rural hospitals have more widespread telehealth capabilities than urban hospitals. There is still great potential to expand these capabilities further, especially in areas that have been hard hit by COVID-19.
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Affiliation(s)
- Neeraj A Puro
- Department of Management Programs, Florida Atlantic University, Boca Raton, Florida
| | - Scott Feyereisen
- Department of Management Programs, Florida Atlantic University, Boca Raton, Florida
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