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Shen H, Chen C, Yan S, Hallensleben C, van der Kleij R, Li M, Dai H, Chavannes N, Zhou Y. Online digital health and informatics education for undergraduate nursing students in China: impacts and recommendations. BMC MEDICAL EDUCATION 2024; 24:803. [PMID: 39061003 PMCID: PMC11282779 DOI: 10.1186/s12909-024-05785-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Digital health plays a vital role in healthcare services. Governments in many countries, including China, are increasingly advocating for the appropriate use of digital technologies to address significant health system challenges. It is crucial to incorporate digital health education into the curriculum for future nurses to adapt to the changes in the digital medical system. This study aimed to evaluate the impact of an online Digital Health and Informatics Course in China on the knowledge and comprehension of key digital health and informatics topics, self-assessment of nursing informatics competencies, and satisfaction among undergraduate nursing students. The findings of this study provide recommendations for the design and implementation of future digital health education. METHODS This study employed a one-group, quasi-experimental mixed-methods design with pre- and post-assessments. The participants received digital health and informatics education through six three-hour online sessions in six interactive days, with online self-learning materials in between. An online quiz and focus group discussions pre- and post the course were designed to evaluate the knowledge and comprehension of key digital health and informatics topics. Also, a validated Chinese version of the Self-assessment of Nursing Informatics Competencies Scale was conducted pre- and post-course to assess self-assessment of nursing informatics competencies. Additionally, all students were invited to participate in an online survey with a performance-focused course evaluation form as well as focus group discussions to gather their feedback on the learning experience and their evaluations of the course. RESULTS A total of 24 undergraduate nursing students were enrolled in the course. All students completed all sessions of this course, resulting in an attendance rate of 100%. Additionally, all students completed both pre- and post-assessments. In terms of the knowledge and comprehension of key digital health and informatics topics, scores of the quiz on knowledge assessment improved from the pre-test [mean pretest score: 78.33 (SD 6.005)] to the post-test [mean post-test score: 83.17 (SD 4.86)] upon completion of the course (P < 0.001). Also, students acknowledged that the course enhanced their knowledge and comprehension of informatics and digital health, the benefits of (nursing) informatics in clinical practice, and the role of health care professionals in informatics and digital health. In terms of self-assessment of nursing informatics competencies, scores on nursing informatics attitudes demonstrated significant improvement (P < 0.001). Furthermore, students reported high satisfaction with various aspects of this course, including the opportunity to explore broad horizons in informatics for future careers, engaging in group discussions, and analyzing case studies on the use of informatics and digital health in clinical practice. CONCLUSIONS This Online Digital Health and Informatics education effectively improved undergraduate nursing students' knowledge and comprehension of the key digital health and informatics topics, nursing informatics attitudes in the self-assessment of nursing informatics competency with high levels of satisfaction. In order to ensure that future education in digital health and informatics for nursing students is in line with the technological advancements in clinical settings, it is necessary to foster collaboration between medical school training and clinical practice. This collaboration should involve the use of clinical examples to illustrate advanced digital health applications and the inclusion of practical exercises on the use of digital health technology in clinical settings.
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Affiliation(s)
- Hongxia Shen
- School of Nursing, Guangzhou Medical University, 195# Dongfeng West Road, Guangzhou, Guangdong, 510182, China.
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands.
- National eHealth Living Lab, Leiden University Medical Centre, Leiden, Netherlands.
| | - Chong Chen
- School of Nursing, Guangzhou Medical University, 195# Dongfeng West Road, Guangzhou, Guangdong, 510182, China
| | - Sijing Yan
- School of Nursing, Guangzhou Medical University, 195# Dongfeng West Road, Guangzhou, Guangdong, 510182, China
| | - Cynthia Hallensleben
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Centre, Leiden, Netherlands
| | - Rianne van der Kleij
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Centre, Leiden, Netherlands
| | - Minyi Li
- School of Nursing, Guangzhou Medical University, 195# Dongfeng West Road, Guangzhou, Guangdong, 510182, China
| | - Huohuo Dai
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Centre, Leiden, Netherlands
| | - Niels Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Centre, Leiden, Netherlands
| | - Ying Zhou
- School of Nursing, Guangzhou Medical University, 195# Dongfeng West Road, Guangzhou, Guangdong, 510182, China.
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Zachrison KS, Cash RE, Boggs KM, Hayden EM, Sullivan AF, Camargo CA. Emergency Department and Health Care System Factors Associated with Telehealth Innovation During the COVID-19 Pandemic. Telemed J E Health 2024; 30:527-535. [PMID: 37523311 DOI: 10.1089/tmj.2023.0265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023] Open
Abstract
Objective: Telehealth capacity may be an important component of pandemic response infrastructure. We aimed to examine changes in the telehealth use by the US emergency departments (EDs) during COVID-19, and to determine whether existing telehealth infrastructure or increased system integration were associated with increased likelihood of use. Methods: We analyzed 2016-2020 National ED Inventory (NEDI)-USA data, including ED characteristics and nature of telehealth use for all US EDs. American Hospital Association data characterized EDs' system integration. An ordinary least-squares regression model obtained one-step-ahead forecast of the expected proportion of EDs using telehealth in 2020 based on growth observed from 2016 to 2019. Among EDs without telehealth in 2019, we used logistic regression models to examine whether system membership or existing telehealth infrastructure were associated with odds of innovation in telehealth use in 2020, accounting for ED characteristics. Results: Of 4,038 EDs responding to telehealth questions in 2019 and 2020 (73% response rate), 3,015 used telehealth in 2020. Telehealth use by US EDs increased more than expected in 2020 (2016: 58%, 2017: 61%, 2018: 65%, 2019: 67%, 2020: 74%, greater than predicted 71%, p = 0.004). Existing telehealth infrastructure was associated with increased telehealth innovation (OR = 1.88, 95% CI: 1.49-2.36), whereas hospital system membership was not (odds ratio [OR] = 1.00, 95% confidence interval [CI]: 0.80-1.25). Conclusions: Telehealth use by US EDs in 2020 grew more than expected and preexisting telehealth infrastructure was associated with increased innovation in its use. Preparation for future pandemic responses may benefit from considering strategies to invest in local infrastructure to facilitate technology adoption and innovation.
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Affiliation(s)
- Kori S Zachrison
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusettes, USA
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusettes, USA
| | - Rebecca E Cash
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusettes, USA
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusettes, USA
| | - Krislyn M Boggs
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusettes, USA
| | - Emily M Hayden
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusettes, USA
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusettes, USA
| | - Ashley F Sullivan
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusettes, USA
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusettes, USA
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusettes, USA
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Çelik MY. Children With Disabilities and Their Mothers During the COVID-19 Pandemic Difficulties Experienced. Clin Pediatr (Phila) 2024; 63:18-31. [PMID: 37036089 PMCID: PMC10086815 DOI: 10.1177/00099228231167382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
The aim of this study was to determine the difficulties experienced by disabled children and their mothers due to the necessity of being at home during the coronavirus 2019 (COVID-19) process. The research is a qualitatively prepared phenomenological-type descriptive study. "Content analysis" was used in the analysis of the interview questions. Semi-structured interview technique was used as the data collection method. It was determined that the disabled child lost the skills he learned during the COVID-19 process; his health was adversely affected; there were disruptions in the education process; behavioral problems began; and he experienced social isolation. As a result, it can be said that both children with disabilities and mothers who care for them try to cope with many difficulties during the COVID-19 process and they are left alone and do not receive support during this process.
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Affiliation(s)
- Melike Yavaş Çelik
- Faculty of Health Sciences, Department of Midwifery, Gaziantep University, Gaziantep, Turkey
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Sarsembayev B, Madyarov V, Kuzikeev M, Kurakbayev E, Utegaliev T. Coronavirus infection and systemic inflammatory reaction syndrome. POLSKI MERKURIUSZ LEKARSKI : ORGAN POLSKIEGO TOWARZYSTWA LEKARSKIEGO 2024; 52:60-66. [PMID: 38518235 DOI: 10.36740/merkur202401110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
OBJECTIVE Aim: The purpose of this study was a clinical approbation of the Kometad drug (international non-proprietary name sodium colistimethate), an antibiotic from the polymyxin group in patients with severe course of confirmed сoronavirus infection in the intensive care unit of the Branch of the I. Zhekenova Municipal Clinical Infectious Diseases Hospital.. PATIENTS AND METHODS Materials and Methods: The methodology is based on both theoretical and empirical methods of scientific cognition. During the study, the features of the Coronavirus infection and the inflammatory reaction syndrome were considered, which became quite a big problem during the pandemic. RESULTS Results: The main indications for the tested drug and the consequences of its use for one age group were also determined. CONCLUSION Conclusions: The conclusion was made about the positive dynamics of the patients' health status, and recommendations were given for further research in this area. The practical significance of this study lies in the first clinical approbation of the Kometad drug, which can be used in medicine to reduce the severity of the systemic inflammatory reaction syndrome and improve the patient's health as a result of the disease of Coronavirus infection, after further clinical trials of the drug with different age groups of patients.
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Affiliation(s)
| | | | - Marat Kuzikeev
- KAZAKH RUSSIAN MEDICAL UNIVERSITY, ALMATY, REPUBLIC OF KAZAKHSTAN
| | - Edil Kurakbayev
- KAZAKHSTAN MEDICAL UNIVERSITY "HIGHER SCHOOL OF PUBLIC HEALTH", ALMATY, REPUBLIC OF KAZAKHSTAN
| | - Timur Utegaliev
- MANGYSTAU REGIONAL MULTIDISCIPLINARY HOSPITAL, AKTAU, REPUBLIC OF KAZAKHSTAN
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Maimaiti Z, Li Z, Li Z, Fu J, Xu C, Chen J, Chai W, Liu L. Ortho-digital dynamics: Exploration of advancing digital health technologies in musculoskeletal disease management. Digit Health 2024; 10:20552076241269613. [PMID: 39148814 PMCID: PMC11325473 DOI: 10.1177/20552076241269613] [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: 02/06/2024] [Accepted: 06/27/2024] [Indexed: 08/17/2024] Open
Abstract
Background Musculoskeletal (MSK) disorders, affecting billions of people worldwide, pose significant challenges to the healthcare system and require effective management models. The rapid development of digital healthcare technologies (DHTs) has revolutionized the healthcare industry. DHT-based interventions have shown promising clinical benefits in managing MSK disorders, alleviating pain, and improving functional impairment. There is, however, no bibliometric analysis of the overall trends on this topic. Methods We extracted all relevant publications from the Web of Science Core Collection (WoSCC) database until April 30, 2023. We performed bibliometric analysis and visualization using CiteSpace, VOSviewer, and R software. Annual trends of publications, countries/regions distributions, funding agencies, institutions, co-cited journals, author contributions, references, core journals, and keywords and research hotspots were analyzed. Results A total of 6810 papers were enrolled in this study. Publications have increased drastically from 16 in 1995 to 1198 in 2022, with 4067 articles published in the last five years. In all, 53 countries contributed with publications to this research area. The United States, the United Kingdom, and China were the most productive countries. Harvard University was the most contributing institution. Regarding keywords, research focuses include artificial intelligence, deep learning, machine learning, telemedicine, rehabilitation, and robotics. Conclusion The COVID-19 pandemic has further accelerated the adoption of DHTs, highlighting the need for remote care options. The analysis reveals the positive impact of DHTs on improving physician productivity, enhancing patient care and quality of life, reducing healthcare expenditures, and predicting outcomes. DHTs are a hot topic of research not only in the clinical field but also in the multidisciplinary intersection of rehabilitation, nursing, education, social and economic fields. The analysis identifies four promising hotspots in the integration of DHTs in MSK pain management, biomechanics assessment, MSK diagnosis and prediction, and robotics and tele-rehabilitation in arthroplasty care.
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Affiliation(s)
- Zulipikaer Maimaiti
- Department of Orthopedics, Beijing Luhe Hospital, Capital Medical University, Beijing, China
- Senior Department of Orthopaedics, The Fourth Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Zhuo Li
- Department of Joint Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Zhiyuan Li
- Senior Department of Orthopaedics, The Fourth Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Jun Fu
- Senior Department of Orthopaedics, The Fourth Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Chi Xu
- Senior Department of Orthopaedics, The Fourth Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Jiying Chen
- Senior Department of Orthopaedics, The Fourth Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Wei Chai
- Senior Department of Orthopaedics, The Fourth Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Liang Liu
- Department of Orthopedics, Beijing Luhe Hospital, Capital Medical University, Beijing, China
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Stead WW, Miller RA, Ohno-Machado L, Bakken S. JAMIA at 30: looking back and forward. J Am Med Inform Assoc 2023; 31:1-9. [PMID: 38134400 PMCID: PMC10746314 DOI: 10.1093/jamia/ocad215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 10/30/2023] [Indexed: 12/24/2023] Open
Affiliation(s)
- William W Stead
- Department of Biomedical Informatics, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, United States
| | - Randolph A Miller
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Alexandria, VA 37232, United States
| | - Lucila Ohno-Machado
- Section of Biomedical Informatics & Data Science, Yale University School of Medicine, New Haven, CT 06520, United States
| | - Suzanne Bakken
- School of Nursing, Department of Biomedical Informatics, Data Science Institute, Columbia University, New York, NY 10032, United States
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Berthelot S, Longtin Y, Margni M, Guertin JR, LeBlanc A, Marx T, Mangou K, Bluteau A, Mantovani D, Mikhaylin S, Bergeron F, Dancause V, Desjardins A, Lahrichi N, Martin D, Sossa CJ, Lachapelle P, Genest I, Schaal S, Gignac A, Tremblay S, Hufty É, Bélanger L, Beatty E. Postpandemic Evaluation of the Eco-Efficiency of Personal Protective Equipment Against COVID-19 in Emergency Departments: Proposal for a Mixed Methods Study. JMIR Res Protoc 2023; 12:e50682. [PMID: 38060296 PMCID: PMC10739239 DOI: 10.2196/50682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 07/21/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has had a profound impact on emergency department (ED) care in Canada and around the world. To prevent transmission of COVID-19, personal protective equipment (PPE) was required for all ED care providers in contact with suspected cases. With mass vaccination and improvements in several infection prevention components, our hypothesis is that the risks of transmission of COVID-19 will be significantly reduced and that current PPE use will have economic and ecological consequences that exceed its anticipated benefits. Evidence is needed to evaluate PPE use so that recommendations can ensure the clinical, economic, and environmental efficiency (ie, eco-efficiency) of its use. OBJECTIVE To support the development of recommendations for the eco-efficient use of PPE, our research objectives are to (1) estimate the clinical effectiveness (reduced transmission, hospitalizations, mortality, and work absenteeism) of PPE against COVID-19 for health care workers; (2) estimate the financial cost of using PPE in the ED for the management of suspected or confirmed COVID-19 patients; and (3) estimate the ecological footprint of PPE use against COVID-19 in the ED. METHODS We will conduct a mixed method study to evaluate the eco-efficiency of PPE use in the 5 EDs of the CHU de Québec-Université Laval (Québec, Canada). To achieve our goals, the project will include four phases: systematic review of the literature to assess the clinical effectiveness of PPE (objective 1; phase 1); cost estimation of PPE use in the ED using a time-driven activity-based costing method (objective 2; phase 2); ecological footprint estimation of PPE use using a life cycle assessment approach (objective 3; phase 3); and cost-consequence analysis and focus groups (integration of objectives 1 to 3; phase 4). RESULTS The first 3 phases have started. The results of these phases will be available in 2023. Phase 4 will begin in 2023 and results will be available in 2024. CONCLUSIONS While the benefits of PPE use are likely to diminish as health care workers' immunity increases, it is important to assess its economic and ecological impacts to develop recommendations to guide its eco-efficient use. TRIAL REGISTRATION PROSPERO CRD42022302598; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=302598. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/50682.
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Affiliation(s)
- Simon Berthelot
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche, CHU de Québec-Université Laval, Québec, QC, Canada
- Département de médecine de famille et de médecine d'urgence, Faculté de médecine, Université Laval, Québec, QC, Canada
| | | | - Manuele Margni
- Ecole Polytechnique, Université de Montréal, Montréal, QC, Canada
| | - Jason Robert Guertin
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche, CHU de Québec-Université Laval, Québec, QC, Canada
- Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Québec, QC, Canada
| | - Annie LeBlanc
- Département de médecine de famille et de médecine d'urgence, Faculté de médecine, Université Laval, Québec, QC, Canada
| | - Tania Marx
- Services des urgences, Centre hospitalier universitaire de Besançon, Besançon, France
| | - Khadidiatou Mangou
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche, CHU de Québec-Université Laval, Québec, QC, Canada
| | - Ariane Bluteau
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche, CHU de Québec-Université Laval, Québec, QC, Canada
| | - Diego Mantovani
- Axe Médecine régénératrice, Centre de recherche, CHU de Québec-Université Laval, Québec, QC, Canada
| | - Sergey Mikhaylin
- EcoFoodLab, Département des sciences de aliments, Institut sur la Nutrition et les Aliments Fonctionnels, Université Laval, Québec, QC, Canada
| | | | | | | | - Nadia Lahrichi
- Ecole Polytechnique, Université de Montréal, Montréal, QC, Canada
| | - Danielle Martin
- Fashion Design and Creative Direction, Toronto Metropolitan University, Toronto, ON, Canada
| | | | | | | | | | - Anne Gignac
- CHU de Québec-Université Laval, Québec, QC, Canada
| | | | - Éric Hufty
- CHU de Québec-Université Laval, Québec, QC, Canada
| | | | - Erica Beatty
- Département de médecine d'urgence, Hôpital Montfort, Ottawa, ON, Canada
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Lawson J, Martin G, Guha P, Gold M, Nimer A, Syed S, Kinross J. Effect of Mixed Reality on Delivery of Emergency Medical Care in a Simulated Environment: A Pilot Randomized Crossover Trial. JAMA Netw Open 2023; 6:e2330338. [PMID: 37639272 PMCID: PMC10463095 DOI: 10.1001/jamanetworkopen.2023.30338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 07/12/2023] [Indexed: 08/29/2023] Open
Abstract
Importance Mixed-reality (MR) technology has the potential to enhance care delivery, but there remains a paucity of evidence for its efficacy and feasibility. Objective To assess the efficacy and feasibility of MR technology to enhance emergency care delivery in a simulated environment. Design, Setting, and Participants This pilot randomized crossover trial was conducted from September to November 2021 at a single center in a high-fidelity simulated environment with participants block randomized to standard care (SC) or MR-supported care (MR-SC) groups. Participants were 22 resident-grade physicians working in acute medical and surgical specialties prospectively recruited from a single UK Academic Health Sciences Centre. Data were analyzed from September to December 2022. Intervention Participants resuscitated a simulated patient who was acutely unwell, including undertaking invasive procedures. Participants completed 2 scenarios and were randomly assigned to SC or MR-SC for the first scenario prior to crossover. The HoloLens 2 MR device provided interactive holographic content and bidirectional audiovisual communication with senior physicians in the MR-SC group. Main Outcomes and Measures The primary outcome was error rate assessed via the Imperial College Error Capture (ICECAP) multidimensional error-capture tool. Secondary outcomes included teamwork (Observational Teamwork Assessment for Surgery [OTAS]; range, 0-6 and Teamwork Skills Assessment for Ward Care [T-SAW-C]; range, 1-5), scenario completion, stress and cognitive load (NASA Task Load Index [NASA-TLX; range 0-100]), and MR device user acceptability. Results A total of 22 physicians (15 males [68.2%]; median [range] age, 28 [25-34] years) were recruited. MR technology significantly reduced the mean (SD) number of errors per scenario compared with SC (5.16 [3.34] vs 8.30 [3.09] errors; P = .003), with substantial reductions in procedural (0.79 [0.75] vs 1.52 [1.20] errors; P = .02), technical (1.95 [1.40] vs 3.65 [2.03] errors; P = .01), and safety (0.37 [0.96] vs 0.96 [0.85] errors; P = .04) domains. MR resulted in significantly greater scenario completion rates vs SC (22 scenarios [100%] vs 14 scenarios [63.6%]; P = .003). It also led to significant improvements in the overall quality of teamwork and interactions vs SC as measured by mean (SD) OTAS (25.41 [6.30] vs 16.33 [5.49]; P < .001) and T-SAW-C (27.35 [6.89] vs 18.37 [6.09]; P < .001) scores. As reported via mean (range) NASA-TLX score, there were significant reductions for MR-SC vs SC in participant temporal demands (38 [20-50] vs 46 [30-70]; P = .03) and significant improvements in self-reported task performance (50 [30-60] vs 39 [10-70]; P = .01). Overall, 19 participants (86.4%) reported that they were more confident in making clinical decisions and undertaking clinical procedures with MR support. Conclusions and Relevance This study found that the use of MR technology reduced error, improved teamwork, and enhanced practitioner confidence when used to support the delivery of simulated emergency medical care. Trial Registration ClinicalTrials.gov Identifier: NCT05870137.
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Affiliation(s)
- Jason Lawson
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Guy Martin
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Payal Guha
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Matthew Gold
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Amr Nimer
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Sadie Syed
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - James Kinross
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
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Roddy MK, Chen P, Jeffery AD, Gutierrez J, Rubenstein M, Campbell C, Blake E, Ward MJ. Telemental health in emergency care settings: A qualitative analysis of considerations for sustainability and spread. Acad Emerg Med 2023; 30:368-378. [PMID: 36786633 PMCID: PMC10983773 DOI: 10.1111/acem.14682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/20/2023] [Accepted: 02/03/2023] [Indexed: 02/15/2023]
Abstract
OBJECTIVES Following rapid uptake of telehealth during the COVID-19 pandemic, we examined barriers and facilitators for sustainability and spread of telemental health video (TMH-V) as policies regarding precautions from the pandemic waned. METHODS We conducted a qualitative study using semistructured interviews and observations guided by RE-AIM. We asked four groups, local clinicians, facility leadership, Veterans, and external partners, about barriers and facilitators impacting patient willingness to engage in TMH-V (reach), quality of care (effectiveness), barriers and facilitators impacting provider uptake (adoption), possible adaptations to TMH-V (implementation), and possibilities for long-term use of TMH-V (maintenance). Interviews were recorded, transcribed, and analyzed using framework analysis. We also observed TMH-V encounters in one emergency department (ED) and one urgent care (UC) to understand how clinicians and Veterans engaged with the technology. RESULTS We conducted 35 interviews with ED/UC clinicians and staff (n = 10), clinical and facility leadership (n = 7), Veterans (n = 5), and external partners (n = 13), January-May 2022. We completed 10 observations. All interviewees were satisfied with the TMH-V program, and interviewees highlighted increased comfort discussing difficult topics for Veterans (reach). Clinicians identified that TMH-V allowed for cross-coverage across sites as well as increased safety and flexibility for clinicians (adoption). Opportunities for improvement include alleviating technological burdens for on-site staff, electronic health record (EHR) modifications to accurately capture workload and modality (telehealth vs. in-person), and standardizing protocols to streamline communication between on-site and remote clinical staff (implementation). Finally, interviewees encouraged its spread (maintenance) and thought there was great potential for service expansion. CONCLUSIONS Interviewees expressed support for continuing TMH-V locally and spread to other sites. Ensuring adequate infrastructure (e.g., EHR integration and technology support) and workforce capacity are key for successful spread. Given the shortage of mental health (MH) clinicians in rural settings, TMH-V represents a promising intervention to increase the access to high-quality emergency MH care.
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Affiliation(s)
- McKenzie K. Roddy
- Veterans Affairs Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), Nashville, Tennessee
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Alvin D. Jeffery
- Veterans Affairs Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), Nashville, Tennessee
- School of Nursing, Vanderbilt University, Nashville, TN, USA
| | | | - Melissa Rubenstein
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Corey Campbell
- VA Tennessee Valley Healthcare System, Nashville, TN, USA
| | - Eric Blake
- VA Tennessee Valley Healthcare System, Nashville, TN, USA
| | - Michael J. Ward
- Veterans Affairs Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), Nashville, Tennessee
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- VA Tennessee Valley Healthcare System, Nashville, TN, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
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Saigí-Rubió F. Promoting telemedicine in Latin America in light of COVID-19. Rev Panam Salud Publica 2023; 47:e17. [PMID: 36909805 PMCID: PMC9976263 DOI: 10.26633/rpsp.2023.17] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/01/2022] [Indexed: 03/06/2023] Open
Abstract
The Faculty of Health Sciences at the Universitat Oberta de Catalunya (Barcelona, Spain) was officially designated a 'World Health Organization (WHO) Collaborating Centre in eHealth' on 5 April 2018. The Centre aims to provide support to countries willing to develop new telemedicine services; to promote the use of eHealth; and to study the adoption and use of mobile health in countries of both the Region of the Americas and Europe. On 11 March 2020, WHO declared COVID-19 a global pandemic given the significant increase in the number of cases worldwide. Since then, the Centre has played an important role in addressing COVID-19 by undertaking fruitful cooperative activities. Lockdowns and social distancing in response to the high contagion rate of COVID-19 were the main triggers for a challenging digital transformation in many sectors, especially in healthcare. In this extreme crisis scenario, the rapid adoption of digital health solutions and technological tools was key to responding to the enormous pressure on healthcare systems. Telemedicine has become a necessary component of clinical practice for the purpose of providing safer patient care, and it has been used to support the healthcare needs of COVID-19 patients and routine primary care patients alike. This article describes the Centre's contribution to the work of the Pan American Health Organization (PAHO) and WHO in supporting Latin American and European countries to develop new telemedicine services and guidance on how to address COVID-19 through digital health solutions. Future actions are also highlighted.
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Affiliation(s)
- Francesc Saigí-Rubió
- Faculty of Health SciencesUniversitat Oberta de Catalunya (UOC)BarcelonaSpainFaculty of Health Sciences, Universitat Oberta de Catalunya (UOC), Barcelona, Spain.
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Ko SQ, Kumar SK, Jacob J, Hooi BMY, Soo M, Nashi N, Cruz MTD, Wah YA, Xin WZ, Smitasin N, Lum L, Archuleta S. Technology-enabled virtual ward for COVID management of the elderly and immunocompromised in Singapore: a descriptive cohort. BMC Infect Dis 2023; 23:102. [PMID: 36809977 PMCID: PMC9942066 DOI: 10.1186/s12879-023-08040-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 01/27/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND To address the hospital bed demand for Delta and Omicron surges in Singapore, the National University Health System (NUHS) developed a COVID Virtual Ward to relieve bed pressures on its three acute hospitals-National University Hospital, Ng Teng Fong General Hospital, Alexandra Hospital. To serve a multilingual population, the COVID Virtual Ward featuring protocolized teleconsultation of high-risk patients, use of a vital signs chatbot, supplemented by home visits where necessary. This study aims to evaluate the safety, outcomes and utilisation of the Virtual Ward as a scalable response to COVID-19 surges. METHODS This is a retrospective cohort study of all patients admitted to the COVID Virtual Ward between 23 September to 9 November 2021. Patients were defined as "early discharge" if they were referred from inpatient COVID-19 wards and "admission avoidance" if they were referred directly from primary care or emergency services. Patient demographics, utilisation measures and clinical outcomes were extracted from the electronic health record system. The primary outcomes were escalation to hospital and mortality. Use of the vital signs chatbot was evaluated by examining compliance levels, need for automated reminders and alerts triggered. Patient experience was evaluated using data extracted from a quality improvement feedback form. RESULTS 238 patients were admitted to the COVID Virtual Ward from 23 September to 9 November, of whom 42% were male, 67.6% of Chinese ethnicity. 43.7% were over the age of 70, 20.5% were immunocompromised, and 36.6% were not fully vaccinated. 17.2% of patients were escalated to hospital and 2.1% of patients died. Patients who were escalated to hospital were more likely to be immunocompromised or to have a higher ISARIC 4C-Mortality Score. There were no missed deteriorations. All patients received teleconsults (median of 5 teleconsults per patient, IQR 3-7). 21.4% of patients received home visits. 77.7% of patients engaged with the vital signs chatbot, with a compliance rate of 84%. All patients would recommend the programme to others in their situation. CONCLUSIONS Virtual Wards are a scalable, safe and patient-centered strategy to care for high risk COVID-19 patients at home. TRIAL REGISTRATION NA.
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Affiliation(s)
- Stephanie Q. Ko
- Division of Advanced Internal Medicine, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Singapore, 119228 Singapore
| | - Shoban Krishna Kumar
- Division of Advanced Internal Medicine, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Singapore, 119228 Singapore
| | - Jonathan Jacob
- Department of Medicine, Alexandra Hospital, 378 Alexandra Road, Singapore, 159964 Singapore
| | - Benjamin M. Y. Hooi
- Division of Advanced Internal Medicine, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Singapore, 119228 Singapore
| | - Michelle Soo
- Division of Advanced Internal Medicine, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Singapore, 119228 Singapore
| | - Norshima Nashi
- Division of Advanced Internal Medicine, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Singapore, 119228 Singapore
| | - Maria Teresa D. Cruz
- Division of Advanced Internal Medicine, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Singapore, 119228 Singapore
| | - Yeo Ai Wah
- Regional Health Service, National University Health System, 1E Kent Ridge Road, Singapore, 119228 Singapore
| | - Wong Zhi Xin
- Division of Advanced Internal Medicine, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Singapore, 119228 Singapore
| | - Nares Smitasin
- Division of Infectious Diseases, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Singapore, 119228 Singapore
| | - Lionel Lum
- Division of Infectious Diseases, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Singapore, 119228 Singapore
| | - Sophia Archuleta
- Division of Advanced Internal Medicine, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Singapore, 119228 Singapore
- Division of Infectious Diseases, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Singapore, 119228 Singapore
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The Impact of Virtual Care in an Emergency Department Observation Unit. Ann Emerg Med 2023; 81:222-233. [PMID: 36253299 DOI: 10.1016/j.annemergmed.2022.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/29/2022] [Accepted: 07/06/2022] [Indexed: 01/25/2023]
Abstract
STUDY OBJECTIVE(S) We report the impact of telemedicine virtual rounding in emergency department observation units (EDOU) on the effectiveness, safety, and cost relative to traditional observation care. METHODS In this retrospective diff-in-diff study, we compared observation visit outcomes from 2 EDOUs before (pre) and after (post) full adoption of telemedicine rounding tele-observation (tele-obs) with usual care in control EDOU and care in a hospital bed in an integrated health system without tele-obs. Tele-obs physicians did not work at the control hospital. Outcomes were the length of stay, total direct costs, admission status, and adverse events (ICU and death). Difference-in-differences modeling evaluated outcomes with covariates including age, sex, payer type, and clinical classification software diagnostic category. Data from a system data warehouse and a cost accounting database were used. RESULTS Of the 20,861 EDOU visits, 15,630 (74.9%) were seen in the preperiod and 6,657 (31.9%) in control EDOU. Of 23,055 non-EDOU inpatient visits assigned to observation status (nonobservation unit), 76% were seen in the preperiod. Adjusted length of stay was not significantly different for tele-obs and control EDOUs (26.4 hours versus 23.5 hours), which remained lower than in hospital settings (37.9 hours). The pre-post diff-in-diff was not significant (P=.78). Inpatient admission status was similar for tele-obs and control EDOUs (20.9% versus 22.4.%) and lower than in hospital settings (30.3%). Prepost odds ratios for inpatient admission and adverse outcomes did not change significantly for all study groups. Adjusted costs increased over time for all settings; however, the prepost median cost change was not significantly different between tele-obs EDOUs and control EDOUs ($162.5 versus $235) and was lower than the change for control hospital settings ($783). Median tele-obs EDOU cost over both periods ($1,541) remained significantly lower than hospital costs ($2,413). CONCLUSION Using tele-obs to manage observation patients in an ED observation unit was not associated with significant differences in length of stay, admission status, measured adverse events, or total direct cost.
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Smith NJ, Bausano BJ, Zachrison KS, Jamtgaard L, Heidt J, Palmer C. Emergency Medicine Telehealth: A Pandemic Becomes a Gateway for Virtual Care in Missouri. MISSOURI MEDICINE 2022; 119:452-459. [PMID: 36337995 PMCID: PMC9616448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Telehealth provides a novel bridge between patient needs and available resources. On-demand telehealth visits provide urgent medical services in a virtual setting. Telehealth can be used to provide care for patients despite geographical distance. Emergency Medicine quickly adapted in response to the COVID-19 pandemic through utilization of telehealth to solve various problems. Tele-triage was used to coordinate COVID-19 testing and treatment. Greater utilization of all current and emerging telehealth modalities could increase access and quality of care for all Missourians.
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Affiliation(s)
- Nathanael J Smith
- Assistant Professor, Department of Emergency Medicine, Boston University School of Medicine and Global Health Equity Fellow at Boston Medical Center, Boston, Massachusetts
| | - Brian J Bausano
- Director of Recruitment and Associate Professor, Department of Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Kori S Zachrison
- Associate Professor of Emergency Medicine at Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Louis Jamtgaard
- Practices in the Emergency Department, Mosaic Life Care, St. Joseph, Missouri
| | - Jonathan Heidt
- Department of Emergency Medicine at University of Missouri - Columbia Health Care, Columbia, Missouri
| | - Christopher Palmer
- Associate Professor of Anesthesiology and Emergency Medicine, Department of Anesthesiology, Division of Critical Care, Department of Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri
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Zachrison KS, Hayden EM, Boggs KM, Boyle TP, Gao J, Samuels-Kalow ME, Marcin JP, Camargo CA. Emergency Departments' Uptake of Telehealth for Stroke Versus Pediatric Care: Observational Study. J Med Internet Res 2022; 24:e33981. [PMID: 35723927 PMCID: PMC9254043 DOI: 10.2196/33981] [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] [Received: 10/01/2021] [Revised: 03/25/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Telehealth for emergency stroke care delivery (telestroke) has had widespread adoption, enabling many hospitals to obtain stroke center certification. Telehealth for pediatric emergency care has been less widely adopted. OBJECTIVE Our primary objective was to determine whether differences in policy or certification requirements contributed to differential uptake of telestroke versus pediatric telehealth. We hypothesized that differences in financial incentives, based on differences in patient volume, prehospital routing policy, and certification requirements, contributed to differential emergency department (ED) adoption of telestroke versus pediatric telehealth. METHODS We used the 2016 National Emergency Department Inventory-USA to identify EDs that were using telestroke and pediatric telehealth services. We surveyed all EDs using pediatric telehealth services (n=339) and a convenience sample of the 1758 EDs with telestroke services (n=366). The surveys characterized ED staffing, transfer patterns, reasons for adoption, and frequency of use. We used bivariate comparisons to examine differences in reasons for adoption and use between EDs with only telestroke services, only pediatric telehealth services, or both. RESULTS Of the 442 EDs surveyed, 378 (85.5%) indicated use of telestroke, pediatric telehealth, or both. EDs with both services were smaller in bed size, volume, and ED attending coverage than those with only telestroke services or only pediatric telehealth services. EDs with telestroke services reported more frequent use, overall, than EDs with pediatric telehealth services: 14.1% (45/320) of EDs with telestroke services reported weekly use versus 2.9% (8/272) of EDs with pediatric telehealth services (P<.001). In addition, 37 out of 272 (13.6%) EDs with pediatric telehealth services reported no consults in the past year. Across applications, the most frequently selected reason for adoption was "improving level of clinical care." Policy-related reasons (ie, for compliance with outside certification or standards or for improving ED performance on quality metrics) were rarely indicated as the most important, but these reasons were indicated slightly more often for telestroke adoption (12/320, 3.8%) than for pediatric telehealth adoption (1/272, 0.4%; P=.003). CONCLUSIONS In 2016, more US EDs had telestroke services than pediatric telehealth services; among EDs with the technology, consults were more frequently made for stroke than for pediatric patients. The most frequently indicated reason for adoption among all EDs was related to clinical care.
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Affiliation(s)
- Kori S Zachrison
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Emily M Hayden
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Krislyn M Boggs
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Tehnaz P Boyle
- Department of Pediatrics, Boston Medical Center, Boston, MA, United States
| | - Jingya Gao
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States
| | | | - James P Marcin
- Department of Pediatrics, University of California Davis School of Medicine, University of California, Sacramento, CA, United States
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States
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Challenges Created by the COVID-19 Pandemic: Pediatric Emergency Medicine and Disaster Management Perspectives. Disaster Med Public Health Prep 2022; 17:e227. [PMID: 35678417 PMCID: PMC9343362 DOI: 10.1017/dmp.2022.153] [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] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The coronavirus disease (COVID-19) pandemic has presented unique challenges to pediatric emergency medicine (PEM) departments. The purpose of this study was to identify these challenges and ascertain how centers overcame barriers in creating solutions to continue to provide high-quality care and keep their workforce safe during the early pandemic. METHODS This is a qualitative study based on semi-structured interviews with physicians in leadership positions who have disaster or emergency management experience. Participants were identified through purposive sampling. Interviews were recorded and transcribed electronically. Themes and codes were extracted from the transcripts by 2 independent coders. Constant comparison analysis was performed until thematic saturation was achieved. Member-checking was completed to ensure trustworthiness. RESULTS Fourteen PEM-trained physicians participated in this study. Communication, leadership and planning, clinical practice, and personal adaptations were the principal themes identified. Recommendations elicited include improving communication strategies; increasing emergency department (ED) representation within hospital-wide incident command; preparing for a surge and accepting adult patients; personal protective equipment supply and usage; developing testing strategies; and adaptations individuals made to their practice to keep themselves and their families safe. CONCLUSIONS By sharing COVID-19 experiences and offering solutions to commonly encountered problems, pediatric EDs may be better prepared for future pandemics.
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Gorbenko K, Mohammed A, Ezenwafor E, Phlegar S, Healy P, Solly T, Nembhard I, Xenophon L, Smith C, Freeman R, Reich D, Mazumdar M. Innovating in a Crisis: A Qualitative Evaluation of a Hospital and Google Partnership to Implement a COVID-19 Inpatient Video Monitoring Program. J Am Med Inform Assoc 2022; 29:1618-1630. [PMID: 35595236 PMCID: PMC9129147 DOI: 10.1093/jamia/ocac081] [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: 10/22/2021] [Revised: 03/10/2022] [Accepted: 05/17/2022] [Indexed: 11/16/2022] Open
Abstract
Objective To describe adaptations necessary for effective use of direct-to-consumer (DTC) cameras in an inpatient setting, from the perspective of health care workers. Methods Our qualitative study included semi-structured interviews and focus groups with clinicians, information technology (IT) personnel, and health system leaders affiliated with the Mount Sinai Health System. All participants either worked in a coronavirus disease 2019 (COVID-19) unit with DTC cameras or participated in the camera implementation. Three researchers coded the transcripts independently and met weekly to discuss and resolve discrepancies. Abiding by inductive thematic analysis, coders revised the codebook until they reached saturation. All transcripts were coded in Dedoose using the final codebook. Results Frontline clinical staff, IT personnel, and health system leaders (N = 39) participated in individual interviews and focus groups in November 2020–April 2021. Our analysis identified 5 areas for effective DTC camera use: technology, patient monitoring, workflows, interpersonal relationships, and infrastructure. Participants described adaptations created to optimize camera use and opportunities for improvement necessary for sustained use. Non-COVID-19 patients tended to decline participation. Discussion Deploying DTC cameras on inpatient units required adaptations in many routine processes. Addressing consent, 2-way communication issues, patient privacy, and messaging about video monitoring could help facilitate a nimble rollout. Implementation and dissemination of inpatient video monitoring using DTC cameras requires input from patients and frontline staff. Conclusions Given the resources and time it takes to implement a usable camera solution, other health systems might benefit from creating task forces to investigate their use before the next crisis.
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Affiliation(s)
- Ksenia Gorbenko
- Icahn School of Medicine at Mount Sinai, Population Health Science and Policy, Mount Sinai Health System, New York, USA.,Institute for Health Care Delivery Science, Mount Sinai Health System, New York, USA
| | - Afrah Mohammed
- Department of Clinical Innovation, Mount Sinai Health System, New York, NY, USA
| | - Edward Ezenwafor
- Institute for Health Care Delivery Science, Mount Sinai Health System, New York, USA
| | - Sydney Phlegar
- Institute for Health Care Delivery Science, Mount Sinai Health System, New York, USA
| | - Patrick Healy
- Department of Clinical Innovation, Mount Sinai Health System, New York, NY, USA
| | | | | | | | - Cardinale Smith
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Robert Freeman
- Department of Clinical Innovation, Mount Sinai Health System, New York, NY, USA
| | - David Reich
- The Mount Sinai Hospital, New York, USA.,Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Madhu Mazumdar
- Icahn School of Medicine at Mount Sinai, Population Health Science and Policy, Mount Sinai Health System, New York, USA.,Institute for Health Care Delivery Science, Mount Sinai Health System, New York, USA
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Wang H, Jia S, Li Z, Duan Y, Tao G, Zhao Z. A Comprehensive Review of Artificial Intelligence in Prevention and Treatment of COVID-19 Pandemic. Front Genet 2022; 13:845305. [PMID: 35559010 PMCID: PMC9086537 DOI: 10.3389/fgene.2022.845305] [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: 12/29/2021] [Accepted: 03/30/2022] [Indexed: 11/13/2022] Open
Abstract
The unprecedented outbreak of the Corona Virus Disease 2019 (COVID-19) pandemic has seriously affected numerous countries in the world from various aspects such as education, economy, social security, public health, etc. Most governments have made great efforts to control the spread of COVID-19, e.g., locking down hard-hit cities and advocating masks for the population. However, some countries and regions have relatively poor medical conditions in terms of insufficient medical equipment, hospital capacity overload, personnel shortage, and other problems, resulting in the large-scale spread of the epidemic. With the unique advantages of Artificial Intelligence (AI), it plays an extremely important role in medical imaging, clinical data, drug development, epidemic prediction, and telemedicine. Therefore, AI is a powerful tool that can help humans solve complex problems, especially in the fight against COVID-19. This study aims to analyze past research results and interpret the role of Artificial Intelligence in the prevention and treatment of COVID-19 from five aspects. In this paper, we also discuss the future development directions in different fields and prove the validity of the models through experiments, which will help researchers develop more efficient models to control the spread of COVID-19.
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Affiliation(s)
- Haishuai Wang
- College of Computer Science, Zhejiang University, Hangzhou, China
| | - Shangru Jia
- Department of Computer and Information Engineering, Tianjin Normal University, Tianjin, China
| | - Zhao Li
- Alibaba-ZJU Joint Research Institute of Frontier Technologies, Zhejiang University, Hangzhou, China
| | - Yucong Duan
- College of Computer Science and Technology, Hainan University, Haikou, China
| | - Guangyu Tao
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Ziping Zhao
- Department of Computer and Information Engineering, Tianjin Normal University, Tianjin, China
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Ostberg N, Ip W, Brown I, Li R. Impact of telemedicine on clinical practice patterns for patients with chest pain in the emergency department. Int J Med Inform 2022; 161:104726. [PMID: 35228006 PMCID: PMC8864961 DOI: 10.1016/j.ijmedinf.2022.104726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 02/19/2022] [Accepted: 02/21/2022] [Indexed: 11/30/2022]
Abstract
Background The outbreak of the COVID-19 pandemic has led to the rapid adoption of novel telemedicine programs within the emergency department (ED) to minimize provider exposure and conserve personal protective equipment (PPE). In this study, we sought to assess how the adoption of telemedicine in the ED impacted clinical order patterns for patients with chest pain. We hypothesize that clinicians would rely more on imaging and laboratory workup for patients receiving telemedicine due to limitation in physical exams. Methods A single-center, retrospective, propensity score matched study was designed for patients presenting with chest pain at an ED. The study period was defined between April 1st, 2020 and September 30th, 2020. The frequency of the most frequent lab, imaging, and medication orders were compared. In addition, poisson regression analysis was performed to compare the overall number of orders between the two groups. Results 455 patients with chest pain who received telemedicine were matched to 455 similar patients without telemedicine with standardized mean difference < 0.1 for all matched covariates. The proportion of frequent lab, imaging, and medication orders were similar between the two groups. However, telemedicine patients received more orders overall (RR, 1.19, 95% CI, 1.11, 1.28, p-value < 0.001) as well as more imaging, lab, and nursing orders. The number of medication orders between the two groups remained similar. Conclusions Frequent labs, imaging, and medications were ordered in similar proportions between the two cohorts. However, telemedicine patients had more orders placed overall. This study is an important objective assessment of the impact that telemedicine has upon clinical practice patterns and can guide future telemedicine implementation after the COVID-19 pandemic.
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On the use of telemedicine in the context of COVID-19: legal aspects and a systematic review of technology. RESEARCH ON BIOMEDICAL ENGINEERING 2022. [PMCID: PMC7954684 DOI: 10.1007/s42600-021-00133-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Purpose The aim of this study was to carry out a systematic review of telemedicine technology and to discuss the role of legislation in the application of telemedicine technology within the scope of COVID-19. Methods The search for papers was conducted in the databases Cochrane Central, MEDLINE, and Embase. The keywords considered for this systematic review were (coronavirus OR “2019-nCoV” OR 2019nCoV OR nCoV2019 OR “nCoV-2019” OR “COVID-19” OR COVID19 OR “HCoV-19” OR HCoV19 OR CoV OR “2019 novel*” OR Ncov OR “n-cov” OR “SARS-CoV-2” OR “SARSCoV-2” OR “SARSCoV2” OR “SARSCoV2” OR SARSCov19 OR “SARS-Cov19” OR “SARS-Cov-19” OR “severe acute respiratory syndrome*” OR ((corona* OR corono*) AND (virus* OR viral* OR virinae*))) AND ((telemedicine OR telehealth OR “remote assessment” OR telemonitoring)). The review process was carried out by six independent reviewers, using the PRISMA-P method. Results As a result, a total of 34 papers were selected, which addressed the study of telemedicine technologies used in times of endemics, epidemics, and pandemics, focusing on COVID-19. Conclusion Telemedicine allows for care in remote areas and at a lower cost to the patient and, in the current situation, it can reduce the number of contagions as well as the occupation of beds in health facilities. Telemedicine may suffer from limitations, mainly due to current legislation, but in this pandemic era of COVID-19, several countries around the world have made their laws more flexible to allow more widespread use of telemedicine.
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Pediatric subspecialty telemedicine use from the patient and provider perspective. Pediatr Res 2022; 91:241-246. [PMID: 33753896 PMCID: PMC7984505 DOI: 10.1038/s41390-021-01443-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 01/25/2021] [Accepted: 01/27/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND To characterize telemedicine use among pediatric subspecialties with respect to clinical uses of telemedicine, provider experience, and patient perceptions during the COVID-19 pandemic. METHODS We performed a mixed-methods study of telemedicine visits across pediatric endocrinology, nephrology, orthopedic surgery, and rheumatology at a large children's hospital. We used deductive analysis to review observational data from 40 video visits. Providers and patients/caregivers were surveyed around areas of satisfaction and communication. RESULTS We found adaptations of telemedicine including shared-screen use and provider-guided parent procedures among others. All providers felt that it was safest for their patients to conduct visits by video, and 72.7% reported completing some component of a clinical exam. Patients rated the areas of being respected by the clinical staff/provider and showing care and concern highly, and the mean overall satisfaction was 86.7 ± 19.3%. CONCLUSIONS Telemedicine has been used to deliver care to pediatric patients during the pandemic, and we found that patients were satisfied with the telemedicine visits during this stressful time and that providers were able to innovate during visits. Telemedicine is a tool that can be successfully adapted to patient and provider needs, but further studies are needed to fully explore its integration in pediatric subspecialty care. IMPACT This study describes telemedicine use at the height of the COVID-19 pandemic from both a provider and patient perspective, in four different pediatric subspecialties. Prior to COVID-19, pediatric telehealth landscape analysis suggested that many pediatric specialty practices had pilot telehealth programs, but there are few published studies evaluating telemedicine performance through the simultaneous patient and provider experience as part of standard care. We describe novel uses and adaptations of telemedicine during a time of rapid deployment in pediatric specialty care.
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Levitt G, Weller JA, Pandurangi A, Thippaiah SM. Impact of SARS-CoV-2 infection and implementation of infection prevention and control (IPC) measures on inpatient psychiatric units. Asian J Psychiatr 2021; 66:102868. [PMID: 34600399 PMCID: PMC8452351 DOI: 10.1016/j.ajp.2021.102868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 08/29/2021] [Accepted: 09/16/2021] [Indexed: 01/10/2023]
Abstract
Psychiatric inpatients are at high risk of acquiring and transmitting communicable diseases such as SARS-CoV-2 (COVID-19). Via chart review, the authors examined a cohort of COVID-positive psychiatric inpatients admitted between March and June of 2020, early in the pandemic, to Valleywise Health Medical Center (VMHC), in Arizona, USA. The goal was to assess the ways in which the virus itself as well as infection prevention and control (IPC) measures affected psychiatric inpatients. Variables examined included demographics, psychiatric diagnoses, COVID-19 symptoms, medical comorbidities, and length of stay. Behavioral health faciltiies encountered significant challenges in blalancing the need for a therapeutic milieu and compliance with IPC measures. During the study period, 39 patients and 15 staff members contracted COVID. All but one COVID-positive staff member provided direct patient care. During the study period, VMHC behavioral health facilities were largely successful in identifying and quarantining COVID-positive patients. The hospital's IPC policies/procedures were constantly updated to incorporate new guidelines and address emerging knowledge about the virus, which may have lowered transmission rates and mitigated potential complications. To preserve quallity and safety of psychiatric care, the therapeutic milieu was altered, which may have adversely affected patient care and/or lengthened hospital stay.
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Affiliation(s)
- Gwen Levitt
- Director of Research for Department of Psychiatry, Valleywise Health Medical Center, Associate Professor (Affiliate Faculty), Creighton University School of Medicine, 2601 E Roosevelt St, Phoenix, AZ, United States.
| | - Jennifer A Weller
- Director of Research for Child/Adolescent Psychiatry, Valleywise Health Medical Center, Associate Professor (Affiliate Faculty), Creighton University School of Medicine, Valleywise Behavioral Health Center - Mesa, 570W Brown Road, Mesa, AZ, United States.
| | - Ananda Pandurangi
- Distinguished Career Professor of Psychiatry, Virginia Commonwealth University, Richmond, VA, United States.
| | - Srinagesh Mannekote Thippaiah
- Assistant Professor of Psychiatry, Creighton University School of Medicine, Valleywise Behavioral Health Center, 5102W Campbell Ave, Phoenix, AZ, United States.
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Hayden EM, Davis C, Clark S, Joshi AU, Krupinski EA, Naik N, Ward MJ, Zachrison KS, Olsen E, Chang BP, Burner E, Yadav K, Greenwald PW, Chandra S. Telehealth in emergency medicine: A consensus conference to map the intersection of telehealth and emergency medicine. Acad Emerg Med 2021; 28:1452-1474. [PMID: 34245649 PMCID: PMC11150898 DOI: 10.1111/acem.14330] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/18/2021] [Accepted: 06/23/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Telehealth has the potential to significantly change the specialty of emergency medicine (EM) and has rapidly expanded in EM during the COVID pandemic; however, it is unclear how EM should intersect with telehealth. The field lacks a unified research agenda with priorities for scientific questions on telehealth in EM. METHODS Through the 2020 Society for Academic Emergency Medicine's annual consensus conference, experts in EM and telehealth created a research agenda for the topic. The multiyear process used a modified Delphi technique to develop research questions related to telehealth in EM. Research questions were excluded from the final research agenda if they did not meet a threshold of at least 80% of votes indicating "important" or "very important." RESULTS Round 1 of voting included 94 research questions, expanded to 103 questions in round 2 and refined to 36 questions for the final vote. Consensus occurred with a final set of 24 important research questions spanning five breakout group topics. Each breakout group domain was represented in the final set of questions. Examples of the questions include: "Among underserved populations, what are mechanisms by which disparities in emergency care delivery may be exacerbated or ameliorated by telehealth" (health care access) and "In what situations should the quality and safety of telehealth be compared to in-person care and in what situations should it be compared to no care" (quality and safety). CONCLUSION The primary finding from the process was the breadth of gaps in the evidence for telehealth in EM and telehealth in general. Our consensus process identified priority research questions for the use of and evaluation of telehealth in EM to fill the current knowledge gaps. Support should be provided to answer the research questions to guide the evidenced-based development of telehealth in EM.
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Affiliation(s)
- Emily M Hayden
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Christopher Davis
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Sunday Clark
- Department of Emergency Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Aditi U Joshi
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Neel Naik
- Department of Emergency Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Michael J Ward
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kori S Zachrison
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Erica Olsen
- Department of Emergency Medicine, Columbia University, College of Physicians and Surgeons, New York, NY, USA
| | - Bernard P Chang
- Department of Emergency Medicine, Columbia University, College of Physicians and Surgeons, New York, NY, USA
| | - Elizabeth Burner
- Department of Emergency Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Kabir Yadav
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Peter W Greenwald
- Department of Emergency Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Shruti Chandra
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, USA
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23
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McAlearney AS, Sieck CJ, Gregory M, Di Tosto G, MacEwan SR, DePuccio MJ, Lee JA, Huerta TR, Walker DM. Examining Patients' Capacity to Use Patient Portals: Insights for Telehealth. Med Care 2021; 59:1067-1074. [PMID: 34593709 PMCID: PMC8595621 DOI: 10.1097/mlr.0000000000001639] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The increase in telehealth in response to the coronavirus disease 2019 pandemic highlights the need to understand patients' capacity to utilize this care modality. Patient portals are a tool whose use requires similar resources and skills as those required for telehealth. Patients' capacity to use patient portals may therefore provide insight regarding patients' readiness and capacity to use telehealth. OBJECTIVE The aim of this study was to examine factors related to patients' capacity to use a patient portal and test the impact of these factors on patients' portal use. RESEARCH DESIGN AND SUBJECTS Using data from a large-scale pragmatic randomized controlled trial of patient portal use, 1081 hospitalized patients responded to survey items that were then mapped onto the 4 dimensions of the Engagement Capacity Framework: self-efficacy, resources, willingness, and capabilities. MEASURES The outcome variable was frequency of outpatient portal use. We evaluated associations between Engagement Capacity Framework dimensions and patient portal use, using regression analyses. RESULTS Patients with fewer resources, fewer capabilities, lower willingness, and lower overall capacity to use patient portals used the portal less; in contrast, those with lower perceived self-efficacy used the portal more. CONCLUSIONS Our findings highlight differences in patients' capacity to use patient portals, which provide an initial understanding of factors that may influence the use of telehealth and offer important guidance in efforts to support patients' telehealth use. Offering patients training tailored to the use of telehealth tools may be particularly beneficial.
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Affiliation(s)
- Ann Scheck McAlearney
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Cynthia J. Sieck
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Megan Gregory
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Gennaro Di Tosto
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Sarah R. MacEwan
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Matthew J. DePuccio
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Jennifer A. Lee
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Timothy R. Huerta
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Daniel M. Walker
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, USA
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24
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Ward MJ, Shuster JL, Mohr NM, Kaboli PJ, Mixon AS, Kemmer J, Campbell C, McNaughton CD. Implementation of Telehealth for Psychiatric Care in VA Emergency Departments and Urgent Care Clinics. Telemed J E Health 2021; 28:985-993. [PMID: 34788149 DOI: 10.1089/tmj.2021.0263] [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: 11/12/2022] Open
Abstract
Objective: To conduct a mixed-methods evaluation of an emergency telehealth intervention in unscheduled settings (emergency department [ED] and urgent care clinic [UCC]) within the Veterans Health Administration (VHA). Materials and Methods: We used the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework to conduct a mixed-methods evaluation of a novel telehealth program implemented in the VHA (Hospital System) in March 2020. We compared the 3 months preimplementation (December 1, 2019 through February 29, 2020) with the 3 months postimplementation (April 1, 2020 through June 30, 2020), then followed sustainability through January 31, 2021. Qualitative data were obtained from surveys and semistructured interviews of staff and providers and analyzed with thematic analysis. Results: Patient demographics and dispositions were similar pre- and postimplementation. The telemental health intervention was used in 319 (83%) unscheduled mental health consultations in the postimplementation phase. After implementation, we did not detect adverse trends in length of stay, 7-day revisits, or 30-day mortality. Use remained high with 82% (n = 1,010) of all unscheduled mental health consultations performed by telemental health in the sustainability phase. Staff and clinician interviews identified the following themes in the use of telemental health: (1) enhanced efficiency without compromising quality and safety, (2) initial apprehension, (3) the COVID-19 pandemic, and (4) sustainability after resolution of the COVID-19 pandemic. Conclusions: This mixed-methods evaluation of unscheduled telemental health implementation found that its use was feasible, did not impact the safety and efficacy of mental health consultations, and was highly acceptable and sustainable in unscheduled settings.
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Affiliation(s)
- Michael J Ward
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Vanderbilt University Department of Biomedical Informatics, Nashville, Tennessee, USA.,VA Tennessee Valley Healthcare System, Nashville, Tennessee, USA
| | - John L Shuster
- VA Tennessee Valley Healthcare System, Nashville, Tennessee, USA
| | - Nicholas M Mohr
- Veterans Rural Health Resource Center-Iowa City, VA Office of Rural Health, and Center for Access and Delivery Research and Evaluation (CADRE) at the Iowa City VA Healthcare System, Iowa City, Iowa, USA.,Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.,Department of Emergency Medicine, and University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.,Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Peter J Kaboli
- Veterans Rural Health Resource Center-Iowa City, VA Office of Rural Health, and Center for Access and Delivery Research and Evaluation (CADRE) at the Iowa City VA Healthcare System, Iowa City, Iowa, USA.,Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Amanda S Mixon
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,VA Tennessee Valley Healthcare System, Nashville, Tennessee, USA
| | - Jennifer Kemmer
- VA Tennessee Valley Healthcare System, Nashville, Tennessee, USA
| | - Corey Campbell
- VA Tennessee Valley Healthcare System, Nashville, Tennessee, USA
| | - Candace D McNaughton
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,VA Tennessee Valley Healthcare System, Nashville, Tennessee, USA
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25
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Vala B, Costa M, Aquino J, Xavier B. Departments of Pediatrics Approach at the Beginning of the COVID-19 Pandemic. PORTUGUESE JOURNAL OF PUBLIC HEALTH 2021. [DOI: 10.1159/000519499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
<b><i>Introduction:</i></b> The novel coronavirus pandemic poses a challenge to healthcare systems’ balance. Since children apparently have milder disease courses, COVID-19 guidelines were not easily adapted to pediatrics. We intend to characterize how the national departments of pediatrics adapted to the pandemic at the beginning and describe the measures that were taken to protect healthcare workers. <b><i>Methods:</i></b> An unvalidated online questionnaire was sent to all departments of pediatrics directors of Portuguese public health system hospitals regarding course of actions taken between April and May 2020 to face the new coronavirus pandemic. Neonatology units were excluded. <b><i>Results:</i></b> Thirty-eight questionnaires were included (93% of public health system departments). All departments divided the pediatric emergency unit into non-COVID-19 and COVID-19 areas: 68% in different areas, 47% divided the same space with a physical barrier and 16% with a line on the floor. Healthcare workers were divided into non-COVID-19 and COVID-19 teams in 71% of the departments. Personal protective equipment mostly used in COVID-19 areas consisted of face shield/goggles (97%) and respirators (95%). Others wore surgical masks (8%). The main clinical criteria for testing were Direção-Geral da Saúde criteria (84%). Presential appointments were maintained in 68% of departments with selected follow-up (81%) and priority-first appointments (73%). <b><i>Discussion:</i></b> National departments of pediatrics faced the pandemic differently and measures taken in the emergency department were more similar. Personal protective equipment was adequate in all wards with occasional overuse, considering national and international guidelines.
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26
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Boczar D, Avila FR, Carter RE, Moore PA, Giardi D, Guliyeva G, Bruce CJ, McLeod CJ, Forte AJ. Using Facial Recognition Tools for Health Assessment. Plast Surg Nurs 2021; 41:232-236. [PMID: 34871291 DOI: 10.1097/psn.0000000000000410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The number of applications for facial recognition technology is increasing due to the improvement in image quality, artificial intelligence, and computer processing power that has occurred during the last decades. Algorithms can be used to convert facial anthropometric landmarks into a computer representation, which can be used to help identify nonverbal information about an individual's health status. This article discusses the potential ways a facial recognition tool can perform a health assessment. Because facial attributes may be considered biometric data, clinicians should be informed about the clinical, ethical, and legal issues associated with its use.
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Affiliation(s)
- Daniel Boczar
- Daniel Boczar, MD, is a postdoctoral research fellow at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Francisco R. Avila, MD, is a postdoctoral research fellow at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Rickey E. Carter, PhD, is a consultant at the Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL
- Pamela A. Moore, DNP, APRN, FNP-BC, is a plastic surgical nurse at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Davide Giardi, MD, is a postdoctoral research fellow at the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
- Gunel Guliyeva, MD, is a postdoctoral research fellow at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Charles J. Bruce MD, is the Chair of the Transformation Innovation Digital, Platform Workstream at the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
- Christopher J. McLeod, PhD, MBChB, is an associate professor of medicine and a consultant at the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
- Antonio Jorge Forte, MD, PhD, is an associate professor of plastic surgery at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
| | - Francisco R Avila
- Daniel Boczar, MD, is a postdoctoral research fellow at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Francisco R. Avila, MD, is a postdoctoral research fellow at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Rickey E. Carter, PhD, is a consultant at the Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL
- Pamela A. Moore, DNP, APRN, FNP-BC, is a plastic surgical nurse at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Davide Giardi, MD, is a postdoctoral research fellow at the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
- Gunel Guliyeva, MD, is a postdoctoral research fellow at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Charles J. Bruce MD, is the Chair of the Transformation Innovation Digital, Platform Workstream at the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
- Christopher J. McLeod, PhD, MBChB, is an associate professor of medicine and a consultant at the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
- Antonio Jorge Forte, MD, PhD, is an associate professor of plastic surgery at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
| | - Rickey E Carter
- Daniel Boczar, MD, is a postdoctoral research fellow at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Francisco R. Avila, MD, is a postdoctoral research fellow at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Rickey E. Carter, PhD, is a consultant at the Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL
- Pamela A. Moore, DNP, APRN, FNP-BC, is a plastic surgical nurse at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Davide Giardi, MD, is a postdoctoral research fellow at the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
- Gunel Guliyeva, MD, is a postdoctoral research fellow at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Charles J. Bruce MD, is the Chair of the Transformation Innovation Digital, Platform Workstream at the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
- Christopher J. McLeod, PhD, MBChB, is an associate professor of medicine and a consultant at the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
- Antonio Jorge Forte, MD, PhD, is an associate professor of plastic surgery at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
| | - Pamela A Moore
- Daniel Boczar, MD, is a postdoctoral research fellow at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Francisco R. Avila, MD, is a postdoctoral research fellow at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Rickey E. Carter, PhD, is a consultant at the Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL
- Pamela A. Moore, DNP, APRN, FNP-BC, is a plastic surgical nurse at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Davide Giardi, MD, is a postdoctoral research fellow at the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
- Gunel Guliyeva, MD, is a postdoctoral research fellow at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Charles J. Bruce MD, is the Chair of the Transformation Innovation Digital, Platform Workstream at the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
- Christopher J. McLeod, PhD, MBChB, is an associate professor of medicine and a consultant at the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
- Antonio Jorge Forte, MD, PhD, is an associate professor of plastic surgery at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
| | - Davide Giardi
- Daniel Boczar, MD, is a postdoctoral research fellow at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Francisco R. Avila, MD, is a postdoctoral research fellow at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Rickey E. Carter, PhD, is a consultant at the Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL
- Pamela A. Moore, DNP, APRN, FNP-BC, is a plastic surgical nurse at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Davide Giardi, MD, is a postdoctoral research fellow at the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
- Gunel Guliyeva, MD, is a postdoctoral research fellow at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Charles J. Bruce MD, is the Chair of the Transformation Innovation Digital, Platform Workstream at the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
- Christopher J. McLeod, PhD, MBChB, is an associate professor of medicine and a consultant at the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
- Antonio Jorge Forte, MD, PhD, is an associate professor of plastic surgery at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
| | - Gunel Guliyeva
- Daniel Boczar, MD, is a postdoctoral research fellow at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Francisco R. Avila, MD, is a postdoctoral research fellow at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Rickey E. Carter, PhD, is a consultant at the Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL
- Pamela A. Moore, DNP, APRN, FNP-BC, is a plastic surgical nurse at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Davide Giardi, MD, is a postdoctoral research fellow at the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
- Gunel Guliyeva, MD, is a postdoctoral research fellow at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Charles J. Bruce MD, is the Chair of the Transformation Innovation Digital, Platform Workstream at the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
- Christopher J. McLeod, PhD, MBChB, is an associate professor of medicine and a consultant at the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
- Antonio Jorge Forte, MD, PhD, is an associate professor of plastic surgery at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
| | - Charles J Bruce
- Daniel Boczar, MD, is a postdoctoral research fellow at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Francisco R. Avila, MD, is a postdoctoral research fellow at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Rickey E. Carter, PhD, is a consultant at the Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL
- Pamela A. Moore, DNP, APRN, FNP-BC, is a plastic surgical nurse at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Davide Giardi, MD, is a postdoctoral research fellow at the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
- Gunel Guliyeva, MD, is a postdoctoral research fellow at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Charles J. Bruce MD, is the Chair of the Transformation Innovation Digital, Platform Workstream at the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
- Christopher J. McLeod, PhD, MBChB, is an associate professor of medicine and a consultant at the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
- Antonio Jorge Forte, MD, PhD, is an associate professor of plastic surgery at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
| | - Christopher J McLeod
- Daniel Boczar, MD, is a postdoctoral research fellow at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Francisco R. Avila, MD, is a postdoctoral research fellow at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Rickey E. Carter, PhD, is a consultant at the Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL
- Pamela A. Moore, DNP, APRN, FNP-BC, is a plastic surgical nurse at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Davide Giardi, MD, is a postdoctoral research fellow at the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
- Gunel Guliyeva, MD, is a postdoctoral research fellow at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Charles J. Bruce MD, is the Chair of the Transformation Innovation Digital, Platform Workstream at the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
- Christopher J. McLeod, PhD, MBChB, is an associate professor of medicine and a consultant at the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
- Antonio Jorge Forte, MD, PhD, is an associate professor of plastic surgery at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
| | - Antonio Jorge Forte
- Daniel Boczar, MD, is a postdoctoral research fellow at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Francisco R. Avila, MD, is a postdoctoral research fellow at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Rickey E. Carter, PhD, is a consultant at the Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL
- Pamela A. Moore, DNP, APRN, FNP-BC, is a plastic surgical nurse at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Davide Giardi, MD, is a postdoctoral research fellow at the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
- Gunel Guliyeva, MD, is a postdoctoral research fellow at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
- Charles J. Bruce MD, is the Chair of the Transformation Innovation Digital, Platform Workstream at the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
- Christopher J. McLeod, PhD, MBChB, is an associate professor of medicine and a consultant at the Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
- Antonio Jorge Forte, MD, PhD, is an associate professor of plastic surgery at the Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL
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Freitas BACD, Prado MRMCD, Toledo LV, Fialho WL, Ayres LFA, Almeida SL, Silva TCSE, Brito MP, Siman AG, Oliveira DMD. Analysis of the service telessaúde-COVID in a municipality of Minas Gerais. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2021; 24:e210036. [PMID: 34406205 DOI: 10.1590/1980-549720210036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 05/25/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to analyze the sociodemographic and clinical profile of patients treated by the remote care service "Telessaúde-COVID" and the factors associated with positive results for COVID-19. METHODS an exploratory and analytical study, carried out based on the analysis of patient records treated by a remote care service called "Telessaúde-COVID". Characteristics of the patients treated and variables related to the service's functioning were evaluated. A descriptive, inferential analysis was performed by logistic regression. RESULTS 1,854 new patients were evaluated and an estimate of 8,630 visits. Female patients were predominant (60.9%), aged between 20 and 59 years (75.9%). The most frequent signs and symptoms were: headache (41.8%), cough (33.3%) and runny nose (30.0%). Of the total number of patients, 66.4% were reported as suspected case of COVID-19 and 14.5% tested positive for COVID-19. The age of 60 years or more was more common among confirmed cases (26.6%). Most patients (80.4%) did not require face-to-face assistance. Confirmed cases of COVID-19 were associated with the age of the patients (OR 1,020; IC95% 1,007 - 1,032); home contact with a confirmed/suspected case (OR 1,902; IC95% 1,178 - 3,070); presence of nausea/vomiting (OR 2,403; IC95% 1,148 - 5,029) and changes in smell (OR 2,827; IC95% 1,294 - 6,176). CONCLUSION "Telessaúde-COVID" was relevant in the management and notification of cases, avoiding the search for face-to-face consultations without clinical indication. Among the suspected cases, positivity for COVID-19 was associated with aging, history of home contact, gastrointestinal and olfactory symptoms.
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Affiliation(s)
| | | | - Luana Vieira Toledo
- Departamento de Medicina e Enfermagem, Universidade Federal de Viçosa - Viçosa (MG), Brasil
| | - Wilmara Lopes Fialho
- Departamento de Medicina e Enfermagem, Universidade Federal de Viçosa - Viçosa (MG), Brasil
| | | | - Sophia Leonel Almeida
- Departamento de Medicina e Enfermagem, Universidade Federal de Viçosa - Viçosa (MG), Brasil
| | | | - Mirna Peçanha Brito
- Departamento de Medicina e Enfermagem, Universidade Federal de Viçosa - Viçosa (MG), Brasil
| | - Andréia Guerra Siman
- Departamento de Medicina e Enfermagem, Universidade Federal de Viçosa - Viçosa (MG), Brasil
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Temsah MH, Alhboob A, Abouammoh N, Al-Eyadhy A, Aljamaan F, Alsohime F, Alabdulhafid M, Ashry A, Bukhari A, ElTahir O, Jamal A, Halwani R, Alhasan K, Alherbish A, Temsah R, Al-Tawfiq JA, Barry M. Pediatric Intensive Care Hybrid-Style Clinical Round During COVID-19 Pandemic: A Pilot Study. Front Pediatr 2021; 9:720203. [PMID: 34490169 PMCID: PMC8417365 DOI: 10.3389/fped.2021.720203] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/21/2021] [Indexed: 01/14/2023] Open
Abstract
Objectives: With the evolving COVID-19 pandemic and the emphasis on social distancing to decrease the spread of SARS-CoV-2 among healthcare workers (HCWs), our pediatric intensive care unit (PICU) piloted the integration of Zoom meetings into clinical rounds. We aimed to explore the feasibility of these hybrid virtual and physical clinical rounds for PICU patients. Design: Mixed quantitative and qualitative deductive thematic content analysis of narrative responses. Setting: PICU, single tertiary-care academic center. Participants: Multidisciplinary PICU HCWs. Interventions: Integration of Zoom meeting into clinical daily PICU rounds. Measurements: For the quantitative part, we gathered the details of daily PICU hybrid rounds in terms of times, number of HCWs, and type of files shared through Zoom. For the qualitative part, open-ended questions were used. Main Results: The physical round took statistically significantly less time (34.68 ± 14.842 min) as compared with the Zoom round (72.45 ± 22.59 min), p < 0.001. The most shared component in the virtual round was chest X-rays (93.5%). Thirty-one HCWs participated in focus group discussions and were included in the analysis. Some of the HCWs' perceived advantages of the hybrid rounds were enabling multidisciplinary discussions, fewer round interruptions, and practicality of virtual discussions. The perceived challenges were the difficulty of the bedside nurse attending the virtual round, decreased teaching opportunities for the trainees, and decreased interactions among the team members, especially if video streaming was not utilized. Conclusions: Multidisciplinary hybrid virtual and physical clinical rounds in the PICU were perceived as feasible by HCWs. The virtual rounds decreased the physical contact between the HCWs, which could decrease the possibility of SARS-CoV-2 spread among the treating team. Still, several components of the hybrid round should be optimized to facilitate the virtual team-members' interactions and enhance the teaching experience.
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Affiliation(s)
- Mohamad-Hani Temsah
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Pediatric Intensive Care Unit, Department of Pediatrics, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Ali Alhboob
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Pediatric Intensive Care Unit, Department of Pediatrics, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Noura Abouammoh
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Family and Community Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ayman Al-Eyadhy
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Pediatric Intensive Care Unit, Department of Pediatrics, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Fadi Aljamaan
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Critical Care Department, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Fahad Alsohime
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Pediatric Intensive Care Unit, Department of Pediatrics, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Majed Alabdulhafid
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Pediatric Intensive Care Unit, Department of Pediatrics, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Ahmad Ashry
- Pediatric Intensive Care Unit, Department of Pediatrics, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Ahmad Bukhari
- Pediatric Intensive Care Unit, Department of Pediatrics, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Omer ElTahir
- Department of Medicine and Clinical Pharmacology, University of Medical Sciences and Technology (UMST), Khartoum, Sudan
| | - Amr Jamal
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Family and Community Medicine, King Saud University, Riyadh, Saudi Arabia
- Evidence-Based Health Care and Knowledge Translation Research Chair, King Saud University, Riyadh, Saudi Arabia
| | - Rabih Halwani
- Sharjah Institute of Medical Research, University of Sharjah, Sharjah, United Arab Emirates
- Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Khalid Alhasan
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Pediatric Intensive Care Unit, Department of Pediatrics, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Adi Alherbish
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Pediatric Intensive Care Unit, Department of Pediatrics, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Reem Temsah
- College of Pharmacy, Alfaisal University, Riyadh, Saudi Arabia
| | - Jaffar A. Al-Tawfiq
- Specialty Internal Medicine and Quality Department, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
- Infectious Disease Division, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
- Infectious Disease Division, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Mazin Barry
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, King Saud University and King Saud University Medical City, Riyadh, Saudi Arabia
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Reeves JJ, Pageler NM, Wick EC, Melton GB, Tan YHG, Clay BJ, Longhurst CA. The Clinical Information Systems Response to the COVID-19 Pandemic. Yearb Med Inform 2021; 30:105-125. [PMID: 34479384 PMCID: PMC8416224 DOI: 10.1055/s-0041-1726513] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE The year 2020 was predominated by the coronavirus disease 2019 (COVID-19) pandemic. The objective of this article is to review the areas in which clinical information systems (CIS) can be and have been utilized to support and enhance the response of healthcare systems to pandemics, focusing on COVID-19. METHODS PubMed/MEDLINE, Google Scholar, the tables of contents of major informatics journals, and the bibliographies of articles were searched for studies pertaining to CIS, pandemics, and COVID-19 through October 2020. The most informative and detailed studies were highlighted, while many others were referenced. RESULTS CIS were heavily relied upon by health systems and governmental agencies worldwide in response to COVID-19. Technology-based screening tools were developed to assist rapid case identification and appropriate triaging. Clinical care was supported by utilizing the electronic health record (EHR) to onboard frontline providers to new protocols, offer clinical decision support, and improve systems for diagnostic testing. Telehealth became the most rapidly adopted medical trend in recent history and an essential strategy for allowing safe and effective access to medical care. Artificial intelligence and machine learning algorithms were developed to enhance screening, diagnostic imaging, and predictive analytics - though evidence of improved outcomes remains limited. Geographic information systems and big data enabled real-time dashboards vital for epidemic monitoring, hospital preparedness strategies, and health policy decision making. Digital contact tracing systems were implemented to assist a labor-intensive task with the aim of curbing transmission. Large scale data sharing, effective health information exchange, and interoperability of EHRs remain challenges for the informatics community with immense clinical and academic potential. CIS must be used in combination with engaged stakeholders and operational change management in order to meaningfully improve patient outcomes. CONCLUSION Managing a pandemic requires widespread, timely, and effective distribution of reliable information. In the past year, CIS and informaticists made prominent and influential contributions in the global response to the COVID-19 pandemic.
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Affiliation(s)
- J. Jeffery Reeves
- Department of Surgery, University of California, San Diego, La Jolla, California, USA
| | - Natalie M. Pageler
- Department of Pediatrics, Division of Critical Care Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Elizabeth C. Wick
- Department of Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Genevieve B. Melton
- Department of Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Yu-Heng Gamaliel Tan
- Department of Orthopedics, Chief Medical Information Officer, Ng Teng Fong General Hospital, National University Health System, Singapore
| | - Brian J. Clay
- Department of Medicine, Division of Biomedical Informatics, University of California, San Diego, La Jolla, CA, USA
| | - Christopher A. Longhurst
- Department of Medicine, Division of Biomedical Informatics, University of California, San Diego, La Jolla, CA, USA
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30
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Patel B, Vilendrer S, Kling SMR, Brown I, Ribeira R, Eisenberg M, Sharp C. Using a Real-Time Locating System to Evaluate the Impact of Telemedicine in an Emergency Department During COVID-19: Observational Study. J Med Internet Res 2021; 23:e29240. [PMID: 34236993 PMCID: PMC8315159 DOI: 10.2196/29240] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/27/2021] [Accepted: 06/13/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Telemedicine has been deployed by health care systems in response to the COVID-19 pandemic to enable health care workers to provide remote care for both outpatients and inpatients. Although it is reasonable to suspect telemedicine visits limit unnecessary personal contact and thus decrease the risk of infection transmission, the impact of the use of such technology on clinician workflows in the emergency department is unknown. OBJECTIVE This study aimed to use a real-time locating system (RTLS) to evaluate the impact of a new telemedicine platform, which permitted clinicians located outside patient rooms to interact with patients who were under isolation precautions in the emergency department, on in-person interaction between health care workers and patients. METHODS A pre-post analysis was conducted using a badge-based RTLS platform to collect movement data including entrances and duration of stay within patient rooms of the emergency department for nursing and physician staff. Movement data was captured between March 2, 2020, the date of the first patient screened for COVID-19 in the emergency department, and April 20, 2020. A new telemedicine platform was deployed on March 29, 2020. The number of entrances and duration of in-person interactions per patient encounter, adjusted for patient length of stay, were obtained for pre- and postimplementation phases and compared with t tests to determine statistical significance. RESULTS There were 15,741 RTLS events linked to 2662 encounters for patients screened for COVID-19. There was no significant change in the number of in-person interactions between the pre- and postimplementation phases for both nurses (5.7 vs 7.0 entrances per patient, P=.07) and physicians (1.3 vs 1.5 entrances per patient, P=.12). Total duration of in-person interactions did not change (56.4 vs 55.2 minutes per patient, P=.74) despite significant increases in telemedicine videoconference frequency (0.6 vs 1.3 videoconferences per patient, P<.001 for change in daily average) and duration (4.3 vs 12.3 minutes per patient, P<.001 for change in daily average). CONCLUSIONS Telemedicine was rapidly adopted with the intent of minimizing pathogen exposure to health care workers during the COVID-19 pandemic, yet RTLS movement data did not reveal significant changes for in-person interactions between staff and patients under investigation for COVID-19 infection. Additional research is needed to better understand how telemedicine technology may be better incorporated into emergency departments to improve workflows for frontline health care clinicians.
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Affiliation(s)
- Birju Patel
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Stacie Vilendrer
- Evaluation Sciences Unit, Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Samantha M R Kling
- Evaluation Sciences Unit, Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Ian Brown
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Ryan Ribeira
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Matthew Eisenberg
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Christopher Sharp
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
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31
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Lee JA, Di Tosto G, McAlearney FA, Miller S, Mezoff E, Venkatesh RD, Huang J, Lightdale JR, Volney J, McAlearney AS. Physician Perspectives about Telemedicine: Considering the Usability of Telemedicine in Response to Coronavirus Disease 2019. J Pediatr Gastroenterol Nutr 2021; 73:42-47. [PMID: 33872292 PMCID: PMC8195679 DOI: 10.1097/mpg.0000000000003149] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/01/2021] [Indexed: 12/10/2022]
Abstract
OBJECTIVE Use of telemedicine in pediatric gastroenterology has increased dramatically in response to the coronavirus disease 2019 (COVID-19) pandemic. The goal of this study was to systematically assess the usability of telemedicine in the field of pediatric gastroenterology. METHODS The previously validated Telehealth Usability Questionnaire was distributed to physician pediatric gastroenterologist members of North American Society for Pediatric Gastroenterology Hepatology and Nutrition. Physician demographic and practice characteristics were collected. Data were analyzed using descriptive, linear mixed-effect, and ordinary least squares regression methods. RESULTS One hundred sixty pediatric gastroenterologists completed the survey. The majority were from academic practice (77%) with experience ranging from trainee (11%) to over 20 years of clinical practice (34%). Most (82%) had no experience with telemedicine before the pandemic. The average usability score (scale 1-5) was 3.87 (σ = 0.67) with the highest domain in the usefulness of telemedicine (μ = 4.29, σ = 0.69) and physician satisfaction (μ = 4.13, σ = 0.79) and the lowest domain in reliability (μ = 3.02, σ = 0.87). When comparing trainees to attending physicians, trainees' responses were almost one point lower on satisfaction with telemedicine (trainee effect = -0.97, Bonferroni adjusted 95% confidence interval = -1.71 to -0.23). CONCLUSION Pediatric gastroenterologists who responded to the survey reported that the technology for telemedicine was usable, but trainees indicated lower levels of satisfaction when compared to attending physicians. Future study is needed to better understand user needs and the impacts of telemedicine on providers with different levels are experience to inform efforts to promote implementation and use of telemedicine beyond the pandemic.
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Affiliation(s)
- Jennifer A. Lee
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition at Nationwide Children's Hospital
- Division of Clinical Informatics at Nationwide Children's Hospital
- Department of Pediatrics
| | - Gennaro Di Tosto
- Department of Family and Community Medicine
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST). The Ohio State University College of Medicine, Columbus, OH
| | | | - Steven Miller
- Department of Pediatrics, Johns Hopkins University, Baltimore, MD
| | - Ethan Mezoff
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition at Nationwide Children's Hospital
- Department of Pediatrics
| | - Rajitha D. Venkatesh
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition at Nationwide Children's Hospital
- Department of Pediatrics
| | - Jeannie Huang
- Department of Pediatrics, University of California
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition at Rady Children's Hospital, San Diego, CA
| | - Jenifer R. Lightdale
- Department of Pediatrics, University of Massachusetts Medical School
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition and UMass Memorial Children's Medical Center, Worcester, MA
| | - Jaclyn Volney
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST). The Ohio State University College of Medicine, Columbus, OH
| | - Ann Scheck McAlearney
- Department of Family and Community Medicine
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST). The Ohio State University College of Medicine, Columbus, OH
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32
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Safaeinili N, Vilendrer S, Williamson E, Zhao Z, Brown-Johnson C, Asch SM, Shieh L. Inpatient Telemedicine Implementation as an Infection Control Response to COVID-19: Qualitative Process Evaluation Study. JMIR Form Res 2021; 5:e26452. [PMID: 34033576 PMCID: PMC8211098 DOI: 10.2196/26452] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/05/2021] [Accepted: 05/19/2021] [Indexed: 12/28/2022] Open
Abstract
Background The COVID-19 pandemic created new challenges to delivering safe and effective health care while minimizing virus exposure among staff and patients without COVID-19. Health systems worldwide have moved quickly to implement telemedicine in diverse settings to reduce infection, but little is understood about how best to connect patients who are acutely ill with nearby clinical team members, even in the next room. Objective To inform these efforts, this paper aims to provide an early example of inpatient telemedicine implementation and its perceived acceptability and effectiveness. Methods Using purposive sampling, this study conducted 15 semistructured interviews with nurses (5/15, 33%), attending physicians (5/15, 33%), and resident physicians (5/15, 33%) on a single COVID-19 unit within Stanford Health Care to evaluate implementation outcomes and perceived effectiveness of inpatient telemedicine. Semistructured interview protocols and qualitative analysis were framed around the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework, and key themes were identified using a rapid analytic process and consensus approach. Results All clinical team members reported wide reach of inpatient telemedicine, with some use for almost all patients with COVID-19. Inpatient telemedicine was perceived to be effective in reducing COVID-19 exposure and use of personal protective equipment (PPE) without significantly compromising quality of care. Physician workflows remained relatively stable, as most standard clinical activities were conducted via telemedicine following the initial intake examination, though resident physicians reported reduced educational opportunities given limited opportunities to conduct physical exams. Nurse workflows required significant adaptations to cover nonnursing duties, such as food delivery and facilitating technology connections for patients and physicians alike. Perceived patient impact included consistent care quality, with some considerations around privacy. Reported challenges included patient–clinical team communication and personal connection with the patient, perceptions of patient isolation, ongoing technical challenges, and certain aspects of the physical exam. Conclusions Clinical team members reported inpatient telemedicine encounters to be acceptable and effective in reducing COVID-19 exposure and PPE use. Nurses adapted their workflows more than physicians in order to implement the new technology and bore a higher burden of in-person care and technical support. Recommendations for improved inpatient telemedicine use include information technology support and training, increased technical functionality, and remote access for the clinical team.
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Affiliation(s)
- Nadia Safaeinili
- Department of Medicine, School of Medicine, Stanford University, Stanford, CA, United States
| | - Stacie Vilendrer
- Department of Medicine, School of Medicine, Stanford University, Stanford, CA, United States
| | - Emma Williamson
- Department of Engineering, Stanford University, Stanford, CA, United States
| | - Zicheng Zhao
- Department of Comparative Medicine, School of Medicine, Stanford University, Stanford, CA, United States
| | - Cati Brown-Johnson
- Department of Medicine, School of Medicine, Stanford University, Stanford, CA, United States
| | - Steven M Asch
- Department of Medicine, School of Medicine, Stanford University, Stanford, CA, United States.,Center for Innovation to Implementation, Veterans Affairs, Palo Alto, CA, United States
| | - Lisa Shieh
- Department of Medicine, School of Medicine, Stanford University, Stanford, CA, United States
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Jaffe TA, Hayden E, Uscher‐Pines L, Sousa J, Schwamm LH, Mehrotra A, Zachrison KS. Telehealth use in emergency care during coronavirus disease 2019: a systematic review. J Am Coll Emerg Physicians Open 2021; 2:e12443. [PMID: 33969356 PMCID: PMC8087945 DOI: 10.1002/emp2.12443] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 03/21/2021] [Accepted: 03/31/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The coronavirus disease 2019 pandemic has presented emergency departments (EDs) with many challenges to address the acute care needs of patients. Many EDs have leveraged telehealth to innovatively respond to these challenges. This review describes the landscape of telehealth initiatives in emergency care that have been described during the coronavirus disease 2019 pandemic. METHODS We conducted a comprehensive, systematic review of the literature using PubMed, supplemented by a review of the gray literature (ie, non-peer reviewed), with input from subject matter experts to identify telehealth initiatives in emergency care during coronavirus disease 2019. We categorized types of telehealth use based on purpose and user characteristics. RESULTS We included 27 papers from our review of the medical literature and another 8 sources from gray literature review. The vast majority of studies (32/35) were descriptive in nature, with the additional inclusion of 2 cohort studies and one randomized clinical trial. There were 5 categories of ED telehealth use during the pandemic: (1) pre-ED evaluation and screening, (2) within ED (including as a means of limiting staff and patient exposure and facilitating consultation with specialists), (3) post-ED discharge monitoring and treatment, (4) educating trainees and health care workers, and (5) coordinating resources and patient care. CONCLUSION Telehealth has been used in a variety of manners during the coronavirus disease 2019 pandemic, enabling innovation in emergency care delivery. The findings from this study can be used by institutions to consider how telehealth may address challenges in emergency care during the coronavirus disease 2019 pandemic and beyond. Because few studies included cost data and given the variability in institutional resources, how organizations implement telehealth programs will likely vary. Future work should further explore barriers and facilitators of innovation, and the impact on care delivery and patient outcomes.
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Affiliation(s)
- Todd A. Jaffe
- Harvard Affiliated Emergency Medicine ResidencyMassachusetts General Hospital and Brigham and Women's HospitalBostonMassachusettsUSA
| | - Emily Hayden
- Department of Emergency MedicineMassachusetts General HospitalBostonMassachusettsUSA
| | | | | | - Lee H. Schwamm
- Department of NeurologyMassachusetts General HospitalBostonMassachusettsUSA
| | - Ateev Mehrotra
- Department of Health Care PolicyHarvard Medical SchoolBostonMassachusettsUSA
| | - Kori S. Zachrison
- Department of Emergency MedicineMassachusetts General HospitalBostonMassachusettsUSA
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Beno S, Ross C, Principi T. Coronavirus disease 2019 in the pediatric emergency department: unique considerations in preparation and response. Curr Opin Pediatr 2021; 33:269-274. [PMID: 33782243 DOI: 10.1097/mop.0000000000001010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW Pediatric Emergency Departments (PEDs) have experienced unique considerations throughout the coronavirus disease 2019 (COVID-19) pandemic. We review the adaptations and challenges surrounding the preparation and response for pediatric emergency patients, with a specific focus on operational modifications, evolving personal protected equipment (PPE) needs, protected resuscitation responses, clinical characteristics in children, and the unintended effects on children and youth. RECENT FINDINGS COVID-19 has thus far proven to have a milder course in children, with manifestations ranging from asymptomatic carriage or typical viral symptoms, to novel clinical entities such as 'COVID toes' and multisystem inflammatory syndrome in children (MIS-C), the latter associated with potentially significant morbidity. It has had an important effect on primary prevention, injury rates, reduced presentations for emergency care, and increased mental health, abuse and neglect rates in children and youth. PEDs have prepared successfully. The most significant adjustments have occurred with screening, testing, and consistent and effective use of PPE, along with protected responses to resuscitation, adaptations to maintain family-centered care, and technological advances in communication and virtual care. Simulation has been key to the successful implementation of many of these strategies. SUMMARY COVID-19 has pushed PEDs to rapidly adapt to evolving clinical and societal needs, with both resultant challenges and positive advances. Further experience and research will guide how in the face of a global pandemic we can further optimize the clinical and operational care of children and youth, ensure robust educational training programs, and maintain provider safety and wellness.
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Affiliation(s)
- Suzanne Beno
- Division of Emergency Medicine, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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35
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Uscher-Pines L, Sousa J, Mehrotra A, Schwamm LH, Zachrison KS. Rising to the Challenges of the Pandemic: Telehealth Innovations in U.S. Emergency Departments. J Am Med Inform Assoc 2021; 28:1910-1918. [PMID: 34022045 PMCID: PMC8194856 DOI: 10.1093/jamia/ocab092] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/10/2021] [Indexed: 11/24/2022] Open
Abstract
Objective During the first 9 months of the coronavirus disease 2019 (COVID-19) pandemic, many emergency departments (EDs) experimented with telehealth applications to reduce virus exposure, decrease visit volume, and conserve personal protective equipment. We interviewed ED leaders who implemented telehealth programs to inform responses to the ongoing COVID-19 pandemic and future emergencies. Materials and Methods From September to November 2020, we conducted semi-structured interviews with ED leaders across the United States. We identified EDs with pandemic-related telehealth programs through literature review and snowball sampling. Maximum variation sampling was used to capture a range of experiences. We used standard qualitative analysis techniques, consisting of both inductive and deductive approaches to identify and characterize themes. Results We completed 15 interviews with EDs leaders in 10 states. From March to November 2020, participants experimented with more than a dozen different types of telehealth applications including tele-isolation, tele-triage, tele-consultation, virtual postdischarge assessment, acute care in the home, and tele-palliative care. Prior experience with telehealth was key for implementation of new applications. Most new telehealth applications turned out to be temporary because they were no longer needed to support the response. The leading barriers to telehealth implementation during the pandemic included technology challenges and the need for “hands-on” implementation support in the ED. Conclusions In response to the COVID-19 pandemic, EDs rapidly implemented many telehealth innovations. Their experiences can inform future responses.
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Affiliation(s)
| | | | | | - Lee H Schwamm
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Kori S Zachrison
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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36
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Halabi R, Smith G, Sylwestrzak M, Clay B, Longhurst CA, Lander L. The Impact of Inpatient Telemedicine on Personal Protective Equipment Savings During the COVID-19 Pandemic: Cross-sectional Study. J Med Internet Res 2021; 23:e28845. [PMID: 33945494 PMCID: PMC8136403 DOI: 10.2196/28845] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/20/2021] [Accepted: 05/01/2021] [Indexed: 11/19/2022] Open
Abstract
With the emergence of the COVID-19 pandemic and shortage of adequate personal protective equipment (PPE), hospitals implemented inpatient telemedicine measures to ensure operational readiness and a safe working environment for clinicians. The utility and sustainability of inpatient telemedicine initiatives need to be evaluated as the number of COVID-19 inpatients is expected to continue declining. In this viewpoint, we describe the use of a rapidly deployed inpatient telemedicine workflow at a large academic medical center and discuss the potential impact on PPE savings. In early 2020, videoconferencing software was installed on patient bedside iPads at two academic medical center teaching hospitals. An internal website allowed providers to initiate video calls with patients in any patient room with an activated iPad, including both COVID-19 and non–COVID-19 patients. Patients were encouraged to use telemedicine technology to connect with loved ones via native apps or videoconferencing software. We evaluated the use of telemedicine technology on patients’ bedside iPads by monitoring traffic to the internal website. Between May 2020 and March 2021, there were a total of 1240 active users of the Video Visits website (mean 112.7, SD 49.0 connection events per month). Of these, 133 (10.7%) connections were made. Patients initiated 63 (47.4%) video calls with family or friends and sent 37 (27.8%) emails with videoconference connection instructions. Providers initiated a total of 33 (24.8%) video calls with the majority of calls initiated in August (n=22, 67%). There was a low level of adoption of inpatient telemedicine capability by providers and patients. With sufficient availability of PPE, inpatient providers did not find a frequent need to use the bedside telemedicine technology, despite a high census of patients with COVID-19. Compared to providers, patients used videoconferencing capabilities more frequently in September and October 2020. We did not find savings of PPE associated with the use of inpatient telemedicine.
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Affiliation(s)
- Reem Halabi
- School of Medicine, University of California, San Diego, San Diego, CA, United States
| | - Geoffrey Smith
- Information Services, University of California San Diego Health, San Diego, CA, United States
| | - Marc Sylwestrzak
- Information Services, University of California San Diego Health, San Diego, CA, United States
| | - Brian Clay
- Information Services, University of California San Diego Health, San Diego, CA, United States.,Health Sciences Department of Biomedical Informatics, University of California, San Diego, San Diego, CA, United States.,Department of Medicine, University of California, San Diego, San Diego, CA, United States
| | - Christopher A Longhurst
- Information Services, University of California San Diego Health, San Diego, CA, United States.,Health Sciences Department of Biomedical Informatics, University of California, San Diego, San Diego, CA, United States.,Department of Pediatrics, University of California, San Diego, San Diego, CA, United States
| | - Lina Lander
- Information Services, University of California San Diego Health, San Diego, CA, United States.,Department of Family Medicine, University of California, San Diego, La Jolla, CA, United States
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Zhang T, Mosier J, Subbian V. Identifying Barriers to and Opportunities for Telehealth Implementation Amidst the COVID-19 Pandemic by Using a Human Factors Approach: A Leap Into the Future of Health Care Delivery? JMIR Hum Factors 2021; 8:e24860. [PMID: 33779566 PMCID: PMC8041052 DOI: 10.2196/24860] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/11/2021] [Accepted: 03/28/2021] [Indexed: 12/16/2022] Open
Abstract
The extensive uptake of telehealth has considerably transformed health care delivery since the beginning of the COVID-19 pandemic and has imposed tremendous challenges to its large-scale implementation and adaptation. Given the shift in paradigm from telehealth as an alternative mechanism of care delivery to telehealth as an integral part of the health system, it is imperative to take a systematic approach to identifying barriers to, opportunities for, and the overall impact of telehealth implementation amidst the current pandemic. In this work, we apply a human factors framework, the Systems Engineering Initiative for Patient Safety model, to guide our holistic analysis and discussion of telehealth implementation, encompassing the health care work system, care processes, and outcomes.
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Affiliation(s)
- Tianyi Zhang
- Department of Systems and Industrial Engineering, College of Engineering, The University of Arizona, Tucson, AZ, United States
| | - Jarrod Mosier
- Department of Biomedical Engineering, The University of Arizona, Tucson, AZ, United States
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep, University of Arizona College of Medicine, Tucson, AZ, United States
- Adult ECMO Service, Banner - University Medical Center Tucson, Tucson, AZ, United States
| | - Vignesh Subbian
- Department of Systems and Industrial Engineering, College of Engineering, The University of Arizona, Tucson, AZ, United States
- Department of Biomedical Engineering, The University of Arizona, Tucson, AZ, United States
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Abstract
The number of applications for facial recognition technology is increasing due to the improvement in image quality, artificial intelligence, and computer processing power that has occurred during the last decades. Algorithms can be used to convert facial anthropometric landmarks into a computer representation, which can be used to help identify nonverbal information about an individual's health status. This article discusses the potential ways a facial recognition tool can perform a health assessment. Because facial attributes may be considered biometric data, clinicians should be informed about the clinical, ethical, and legal issues associated with its use.
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Subash M, Sakumoto M, Bass J, Hong P, Muniyappa A, Pierce L, Purmal C, Ramaswamy P, Sono R, Uptegraft C, Feinstein D, Khanna R. The emerging role of clinical informatics fellows in service learning during the COVID-19 pandemic. J Am Med Inform Assoc 2021; 28:487-493. [PMID: 33164076 PMCID: PMC7717323 DOI: 10.1093/jamia/ocaa241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/08/2020] [Accepted: 09/15/2020] [Indexed: 11/16/2022] Open
Abstract
Objective The study sought to describe the contributions of clinical informatics (CI) fellows to their institutions’ coronavirus disease 2019 (COVID-19) response. Materials and Methods We designed a survey to capture key domains of health informatics and perceptions regarding fellows’ application of their CI skills. We also conducted detailed interviews with select fellows and described their specific projects in a brief case series. Results Forty-one of the 99 CI fellows responded to our survey. Seventy-five percent agreed that they were “able to apply clinical informatics training and interest to the COVID-19 response.” The most common project types were telemedicine (63%), reporting and analytics (49%), and electronic health record builds and governance (32%). Telehealth projects included training providers on existing telehealth tools, building entirely new virtual clinics for video triage of COVID-19 patients, and pioneering workflows and implementation of brand-new emergency department and inpatient video visit types. Analytics projects included reports and dashboards for institutional leadership, as well as developing digital contact tracing tools. For electronic health record builds, fellows directly contributed to note templates with embedded screening and testing guidance, adding COVID-19 tests to order sets, and validating clinical triage workflows. Discussion Fellows were engaged in projects that span the breadth of the CI specialty and were able to make system-wide contributions in line with their educational milestones. Conclusions CI fellows contributed meaningfully and rapidly to their institutions’ response to the COVID-19 pandemic.
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Affiliation(s)
- Meera Subash
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Matthew Sakumoto
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Jeremy Bass
- Department of Emergency Medicine, University of California, San Diego, La Jolla, California, USA
| | - Peter Hong
- Department of Biomedical Informatics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Anoop Muniyappa
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Logan Pierce
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Colin Purmal
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Priya Ramaswamy
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Reiri Sono
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Colby Uptegraft
- Department of Biomedical Informatics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - David Feinstein
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Raman Khanna
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
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Yan C, Zhang X, Gao C, Wilfong E, Casey J, France D, Gong Y, Patel M, Malin B, Chen Y. Collaboration Structures in COVID-19 Critical Care: Retrospective Network Analysis Study. JMIR Hum Factors 2021; 8:e25724. [PMID: 33621187 PMCID: PMC7942392 DOI: 10.2196/25724] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/12/2021] [Accepted: 02/22/2021] [Indexed: 01/26/2023] Open
Abstract
Background Few intensive care unit (ICU) staffing studies have examined the collaboration structures of health care workers (HCWs). Knowledge about how HCWs are connected to the care of critically ill patients with COVID-19 is important for characterizing the relationships among team structures, care quality, and patient safety. Objective We aimed to discover differences in the teamwork structures of COVID-19 critical care by comparing HCW collaborations in the management of critically ill patients with and without COVID-19. Methods In this retrospective study, we used network analysis methods to analyze the electronic health records (EHRs) of 76 critically ill patients (with COVID-19: n=38; without COVID-19: n=38) who were admitted to a large academic medical center, and to learn about HCW collaboration. We used the EHRs of adult patients who were admitted to the COVID-19 ICU at the Vanderbilt University Medical Center (Nashville, Tennessee, United States) between March 17, 2020, and May 31, 2020. We matched each patient according to age, gender, and their length of stay. Patients without COVID-19 were admitted to the medical ICU between December 1, 2019, and February 29, 2020. We used two sociometrics—eigencentrality and betweenness—to quantify HCWs’ statuses in networks. Eigencentrality characterizes the degree to which an HCW is a core person in collaboration structures. Betweenness centrality refers to whether an HCW lies on the path of other HCWs who are not directly connected. This sociometric was used to characterize HCWs’ broad skill sets. We measured patient staffing intensity in terms of the number of HCWs who interacted with patients’ EHRs. We assessed the statistical differences in the core and betweenness statuses of HCWs and the patient staffing intensities of COVID-19 and non–COVID-19 critical care, by using Mann-Whitney U tests and reporting 95% CIs. Results HCWs in COVID-19 critical care were more likely to frequently work with each other (eigencentrality: median 0.096) than those in non–COVID-19 critical care (eigencentrality: median 0.057; P<.001). Internal medicine physicians in COVID-19 critical care had higher core statuses than those in non–COVID-19 critical care (P=.001). Nurse practitioners in COVID-19 care had higher betweenness statuses than those in non–COVID-19 care (P<.001). Compared to HCWs in non–COVID-19 settings, the EHRs of critically ill patients with COVID-19 were used by a larger number of internal medicine nurse practitioners (P<.001), cardiovascular nurses (P<.001), and surgical ICU nurses (P=.002) and a smaller number of resident physicians (P<.001). Conclusions Network analysis methodologies and data on EHR use provide a novel method for learning about differences in collaboration structures between COVID-19 and non–COVID-19 critical care. Health care organizations can use this information to learn about the novel changes that the COVID-19 pandemic has imposed on collaboration structures in urgent care.
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Affiliation(s)
- Chao Yan
- Department of Electrical Engineering & Computer Science, Vanderbilt University, Nashville, TN, United States
| | - Xinmeng Zhang
- Department of Electrical Engineering & Computer Science, Vanderbilt University, Nashville, TN, United States
| | - Cheng Gao
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Erin Wilfong
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Jonathan Casey
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Daniel France
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Yang Gong
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Mayur Patel
- Department of Hearing & Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, United States.,Geriatric Research and Education Clinical Center, Veteran Affairs Tennessee Valley Healthcare System, Nashville, TN, United States.,Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, United States.,Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Bradley Malin
- Department of Electrical Engineering & Computer Science, Vanderbilt University, Nashville, TN, United States.,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States.,Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - You Chen
- Department of Electrical Engineering & Computer Science, Vanderbilt University, Nashville, TN, United States.,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
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Samuels-Kalow M, Jaffe T, Zachrison K. Digital disparities: designing telemedicine systems with a health equity aim. Emerg Med J 2021; 38:474-476. [PMID: 33674277 DOI: 10.1136/emermed-2020-210896] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/13/2021] [Accepted: 02/14/2021] [Indexed: 11/03/2022]
Abstract
The use of telemedicine has grown immensely during the COVID-19 pandemic. Telemedicine provides a means to deliver clinical care while limiting patient and provider exposure to the COVID-19. As such, telemedicine is finding applications in a variety of clinical environments including primary care and the acute care setting and the array of patient populations who use telemedicine continues to grow. Yet as telehealth becomes ubiquitous, it is critical to consider its potential to exacerbate disparities in care. Challenges accessing technology and digital literacy, for example, disproportionately impact older patients and those living in poverty. When implemented with the consideration of health disparities, telemedicine provides an opportunity to address these inequities. This manuscript explores potential mechanisms by which telemedicine may play a role in exacerbating or ameliorating disparities in care. We further describe a framework and suggested strategies with which to implement telemedicine systems to improve health equity.
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Affiliation(s)
| | - Todd Jaffe
- Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kori Zachrison
- Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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Shah AC, Badawy SM. Telemedicine in Pediatrics: Systematic Review of Randomized Controlled Trials. JMIR Pediatr Parent 2021; 4:e22696. [PMID: 33556030 PMCID: PMC8078694 DOI: 10.2196/22696] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 01/07/2021] [Accepted: 02/01/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Telemedicine modalities, such as videoconferencing, are used by health care providers to remotely deliver health care to patients. Telemedicine use in pediatrics has increased in recent years. This has resulted in improved health care access, optimized disease management, progress in the monitoring of health conditions, and fewer exposures to patients with illnesses during pandemics (eg, the COVID-19 pandemic). OBJECTIVE We aimed to systematically evaluate the most recent evidence on the feasibility and accessibility of telemedicine services, patients' and care providers' satisfaction with these services, and treatment outcomes related to telemedicine service use among pediatric populations with different health conditions. METHODS Studies were obtained from the PubMed database on May 10, 2020. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. In this review, we included randomized controlled trials from the last 10 years that used a telemedicine approach as a study intervention or assessed telemedicine as a subspecialty of pediatric care. Titles and abstracts were independently screened based on the eligibility criteria. Afterward, full texts were retrieved and independently screened based on the eligibility criteria. A standardized form was used to extract the following data: publication title, first author's name, publication year, participants' characteristics, study design, the technology-based approach that was used, intervention characteristics, study goals, and study findings. RESULTS In total, 11 articles met the inclusion criteria and were included in this review. All studies were categorized as randomized controlled trials (8/11, 73%) or cluster randomized trials (3/11, 27%). The number of participants in each study ranged from 22 to 400. The health conditions that were assessed included obesity (3/11, 27%), asthma (2/11, 18%), mental health conditions (1/11, 9%), otitis media (1/11, 9%), skin conditions (1/11, 9%), type 1 diabetes (1/11, 9%), attention deficit hyperactivity disorder (1/11, 9%), and cystic fibrosis-related pancreatic insufficiency (1/11). The telemedicine approaches that were used included patient and doctor videoconferencing visits (5/11, 45%), smartphone-based interventions (3/11, 27%), telephone counseling (2/11, 18%), and telemedicine-based screening visits (1/11, 9%). The telemedicine interventions in all included studies resulted in outcomes that were comparable to or better than the outcomes of control groups. These outcomes were related to symptom management, quality of life, satisfaction, medication adherence, visit completion rates, and disease progression. CONCLUSIONS Although more research is needed, the evidence from this review suggests that telemedicine services for the general public and pediatric care are comparable to or better than in-person services. Patients, health care professionals, and caregivers may benefit from using both telemedicine services and traditional, in-person health care services. To maximize the potential of telemedicine, future research should focus on improving patients' access to care, increasing the cost-effectiveness of telemedicine services, and eliminating barriers to telemedicine use.
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Affiliation(s)
- Aashaka C Shah
- University of Illinois College of Medicine, Chicago, IL, United States
| | - Sherif M Badawy
- Division of Hematology, Oncology, Neuro-Oncology and Stem Cell Transplant, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, United States.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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Anyanwu EC, Ward RP, Shah A, Arora V, Umscheid CA. A Mobile App to Facilitate Socially Distanced Hospital Communication During COVID-19: Implementation Experience. JMIR Mhealth Uhealth 2021; 9:e24452. [PMID: 33513562 PMCID: PMC7903979 DOI: 10.2196/24452] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 12/06/2020] [Accepted: 01/29/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND COVID-19 has significantly altered health care delivery, requiring clinicians and hospitals to adapt to rapidly changing hospital policies and social distancing guidelines. At our large academic medical center, clinicians reported that existing information on distribution channels, including emails and hospital intranet posts, was inadequate to keep everyone abreast with these changes. To address these challenges, we adapted a mobile app developed in-house to communicate critical changes in hospital policies and enable direct telephonic communication between clinical team members and hospitalized patients, to support social distancing guidelines and remote rounding. OBJECTIVE This study aimed to describe the unique benefits and challenges of adapting an app developed in-house to facilitate communication and remote rounding during COVID-19. METHODS We adapted moblMD, a mobile app available on the iOS and Android platforms. In conjunction with our Hospital Incident Command System, resident advisory council, and health system innovation center, we identified critical, time-sensitive policies for app usage. A shared collaborative document was used to align app-based communication with more traditional communication channels. To minimize synchronization efforts, we particularly focused on high-yield policies, and the time of last review and the corresponding reviewer were noted for each protocol. To facilitate social distancing and remote patient rounding, the app was also populated with a searchable directory of numbers to patient bedside phones and hospital locations. We monitored anonymized user activity from February 1 to July 31, 2020. RESULTS On its first release, 1104 clinicians downloaded moblMD during the observation period, of which 46% (n=508) of downloads occurred within 72 hours of initial release. COVID-19 policies in the app were reviewed most commonly during the first week (801 views). Users made sustained use of hospital phone dialing features, including weekly peaks of 2242 phone number dials, 1874 directory searches, and 277 patient room phone number searches through the last 2 weeks of the observation period. Furthermore, clinicians submitted 56 content- and phone number-related suggestions through moblMD. CONCLUSIONS We rapidly developed and deployed a communication-focused mobile app early during COVID-19, which has demonstrated initial and sustained value among clinicians in communicating with in-patients and each other during social distancing. Our internal innovation benefited from our team's familiarity with institutional structures, short feedback loops, limited security and privacy implications, and a path toward sustainability provided by our innovation center. Challenges in content management were overcome through synchronization efforts and timestamping review. As COVID-19 continues to alter health care delivery, user activity metrics suggest that our solution will remain important in our efforts to continue providing safe and up-to-date clinical care.
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Affiliation(s)
- Emeka C Anyanwu
- Section of Cardiology, University of Chicago, Chicago, IL, United States
| | - R Parker Ward
- Section of Cardiology, University of Chicago, Chicago, IL, United States
| | - Atman Shah
- Section of Cardiology, University of Chicago, Chicago, IL, United States
| | - Vineet Arora
- Section of General Internal Medicine, University of Chicago, Chicago, IL, United States.,Center for Healthcare Delivery Science and Innovation, University of Chicago, Chicago, IL, United States
| | - Craig A Umscheid
- Section of General Internal Medicine, University of Chicago, Chicago, IL, United States.,Center for Healthcare Delivery Science and Innovation, University of Chicago, Chicago, IL, United States
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Alexander GL, Powell KR, Deroche CB. An evaluation of telehealth expansion in U.S. nursing homes. J Am Med Inform Assoc 2021; 28:342-348. [PMID: 33164054 PMCID: PMC7883984 DOI: 10.1093/jamia/ocaa253] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 09/24/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE This research brief contains results from a national survey about telehealth use reported in a random sample of U.S. nursing homes. METHODS AND MATERIALS The sample includes nursing homes (N = 664) that completed surveys about information technology maturity, including telehealth use, beginning January 1, 2019, and ending August 4, 2020. A pre/post design was employed to examine differences in nursing home telehealth use for nursing homes completing surveys prior to and after telehealth expansion, on March 6, 2020. We calculated a cumulative telehealth score using survey data from 6 questions about extent of nursing home telehealth use (score range 0-42). We calculated proportions of nursing homes using telehealth and used logistic regression to look for differences in nursing homes based on organizational characteristics and odds ratios. RESULTS Significant relationships were found between nursing home characteristics and telehealth use, and specifically, larger metropolitan homes reported greater telehealth use. Ownership had little effect on telehealth use. Nursing homes postexpansion used telehealth applications for resident evaluation 11.24 times more (P < .01) than did nursing homes pre-expansion. DISCUSSION Administrators completing our survey reported a wide range of telehealth use, including approximately 16% having no telehealth use and 5% having the maximum amount of telehealth use. Mean telehealth use scores reported by the majority of these nursing homes is on the lower end of the range. CONCLUSIONS One solution for the current pandemic is to encourage the proliferation of telehealth with continued relaxed regulations, which can reduce isolation and preserve limited resources (eg, personal protective equipment) while maintaining proper distancing parameters.
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Affiliation(s)
| | - Kimberly R Powell
- Sinclair School of Nursing, University of Missouri, Columbia, Missouri, USA
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Gunasekeran DV, Tham YC, Ting DSW, Tan GSW, Wong TY. Digital health during COVID-19: lessons from operationalising new models of care in ophthalmology. LANCET DIGITAL HEALTH 2021; 3:e124-e134. [PMID: 33509383 DOI: 10.1016/s2589-7500(20)30287-9] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/11/2020] [Accepted: 11/18/2020] [Indexed: 12/13/2022]
Abstract
The COVID-19 pandemic has resulted in massive disruptions within health care, both directly as a result of the infectious disease outbreak, and indirectly because of public health measures to mitigate against transmission. This disruption has caused rapid dynamic fluctuations in demand, capacity, and even contextual aspects of health care. Therefore, the traditional face-to-face patient-physician care model has had to be re-examined in many countries, with digital technology and new models of care being rapidly deployed to meet the various challenges of the pandemic. This Viewpoint highlights new models in ophthalmology that have adapted to incorporate digital health solutions such as telehealth, artificial intelligence decision support for triaging and clinical care, and home monitoring. These models can be operationalised for different clinical applications based on the technology, clinical need, demand from patients, and manpower availability, ranging from out-of-hospital models including the hub-and-spoke pre-hospital model, to front-line models such as the inflow funnel model and monitoring models such as the so-called lighthouse model for provider-led monitoring. Lessons learnt from operationalising these models for ophthalmology in the context of COVID-19 are discussed, along with their relevance for other specialty domains.
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Affiliation(s)
- Dinesh V Gunasekeran
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yih-Chung Tham
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Duke-NUS Medical School, Singapore
| | - Daniel S W Ting
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Duke-NUS Medical School, Singapore
| | - Gavin S W Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Duke-NUS Medical School, Singapore
| | - Tien Y Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Duke-NUS Medical School, Singapore.
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Toccafondi G, Di Marzo F, Sartelli M, Sujan M, Smyth M, Bowie P, Cardi M, Cardi M. Will the COVID-19 pandemic transform infection prevention and control in surgery? Seeking leverage points for organizational learning. Int J Qual Health Care 2021; 33:51-55. [PMID: 33432983 PMCID: PMC7802066 DOI: 10.1093/intqhc/mzaa137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 12/08/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND In response to the coronavirus disease of 2019 (COVID-19) pandemic, healthcare systems worldwide have stepped up their infection prevention and control efforts in order to reduce the spread of the infection. Behaviours, such as hand hygiene, screening and cohorting of patients, and the appropriate use of antibiotics have long been recommended in surgery, but their implementation has often been patchy. METHODS The current crisis presents an opportunity to learn about how to improve infection prevention and control and surveillance (IPCS) behaviours. The improvements made were mainly informal, quick and stemming from the frontline rather than originating from formal organizational structures. The adaptations made and the expertise acquired have the potential for triggering deeper learning and to create enduring improvements in the routine identification and management of infections relating to surgery. RESULTS This paper aims to illustrate how adopting a human factors and ergonomics perspective can provide insights into how clinical work systems have been adapted and reconfigured in order to keep patients and staff safe. CONCLUSION For achieving sustainable change in IPCS practices in surgery during COVID-19 and beyond we need to enhance organizational learning potentials.
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Affiliation(s)
- Giulio Toccafondi
- Cinical risk Management and Patient Safety Center, Via Pietro Dazzi 1, 50141, Firenze; Italy
| | - Francesco Di Marzo
- UOC Chirurgia Generale, Ospedale Valtiberina, Sansepolcro, Usl Toscana Sud‐Est, Viale Galileo Galilei, 101, 52037 Sansepolcro AR, Italy
| | - Massimo Sartelli
- UOC Chirurgia Generale, Dipartimento chirurgia maggiore oncologica Ospedale di Macerata, – Asur 9 Via Santa Lucia, 2, 62100 Macerata MC, Italy
| | - Mark Sujan
- Human Factors Everywhere Ltd., UK and Warwick Medical School, University of Warwick Coventry, CV4 7AL, UK
| | - Molly Smyth
- Chartered Institute of Ergonomics and Human Factors, The Courtyard, Wootton Park, Wootton Wawen, Warwickshire B95 6HJ, UK
| | - Paul Bowie
- NHS Education for Scotland, UK, Westport 102, Edinburgh Westport 102, West Port, Edinburgh, EH3, 9DN, UK
| | - Martina Cardi
- Associate Architect of Bryden Wood, UK 100 Gray’s Inn Road, London, UK
| | - Maurizio Cardi
- Università “La Sapienza”, Dipartimento di Chirurgia Pietro Valdoni, Viale del Policlinico, 155 00161, Roma, Italy
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Lin CT, Bookman K, Sieja A, Markley K, Altman RL, Sippel J, Perica K, Reece L, Davis C, Horowitz E, Pisney L, Sottile PD, Kao D, Adrian B, Szkil M, Griffin J, Youngwerth J, Drew B, Pell J. Clinical informatics accelerates health system adaptation to the COVID-19 pandemic: examples from Colorado. J Am Med Inform Assoc 2020; 27:1955-1963. [PMID: 32687152 PMCID: PMC7454679 DOI: 10.1093/jamia/ocaa171] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/07/2020] [Accepted: 07/17/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Large health systems responding to the coronavirus disease 2019 (COVID-19) pandemic face a broad range of challenges; we describe 14 examples of innovative and effective informatics interventions. MATERIALS AND METHODS A team of 30 physician and 17 nurse informaticists with an electronic health record (EHR) and associated informatics tools. RESULTS To meet the demands posed by the influx of patients with COVID-19 into the health system, the team built solutions to accomplish the following goals: 1) train physicians and nurses quickly to manage a potential surge of hospital patients; 2) build and adjust interactive visual pathways to guide decisions; 3) scale up video visits and teach best-practice communication; 4) use tablets and remote monitors to improve in-hospital and posthospital patient connections; 5) allow hundreds of physicians to build rapid consensus; 6) improve the use of advance care planning; 7) keep clinicians aware of patients' changing COVID-19 status; 8) connect nurses and families in new ways; 9) semi-automate Crisis Standards of Care; and 10) predict future hospitalizations. DISCUSSION During the onset of the COVID-19 pandemic, the UCHealth Joint Informatics Group applied a strategy of "practical informatics" to rapidly translate critical leadership decisions into understandable guidance and effective tools for patient care. CONCLUSION Informatics-trained physicians and nurses drew upon their trusted relationships with multiple teams within the organization to create practical solutions for onboarding, clinical decision-making, telehealth, and predictive analytics.
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Affiliation(s)
- Chen-Tan Lin
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Kelly Bookman
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Amber Sieja
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Richard L Altman
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jeffrey Sippel
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | | | - Christopher Davis
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Larissa Pisney
- Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Peter D Sottile
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - David Kao
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | | | | | - Jeanie Youngwerth
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Jonathan Pell
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
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Candel BGJ, Vaes SMM, van Bree EM, Groenen SMA, Derkx F, Mignot LAA, de Groot B. Telemedicine in the emergency department to decrease personal protective equipment use: a before-and-after study. Emerg Med J 2020; 38:224-228. [PMID: 33355305 DOI: 10.1136/emermed-2020-210292] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/22/2020] [Accepted: 11/11/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Personal protective equipment (PPE) used by healthcare workers was scarce during the COVID-19 pandemic. The aim of this study was to assess whether telemedicine (using iPads) reduced PPE use in emergency department (ED) patients who were treated in contact isolation, and whether telemedicine had a positive effect on patient anxiety and satisfaction. METHODS We conducted a prospective single centre before-and-after study including ED patients ≥18 years who were treated in contact isolation. PPE use, the Hospital Anxiety Scale and the 15-item Picker Patient Experience Questionnaire were compared between the control period (8 April to 14 April 2020) and intervention period (15 April to 24 April 2020). RESULTS We included 25 patients in each period. PPE use per patient was higher for physicians in the control period (mean 1.7; 95% CI 1.5 to 1.9) compared with the intervention period (mean 1.2; 95% CI 1.0 to 1.3, p<0.01). Total PPE use per patient contact for ED physicians decreased from 42 out of 42 patient contacts in the control period, to 29 out of 66 patient contacts in the intervention period (difference 54.3%; 95% CI 50.1% to 58.6%, p<0.01). Reported anxiety and satisfaction were not significantly different. CONCLUSION PPE use by physicians can successfully be reduced by using telemedicine in the ED without increasing anxiety or dissatisfaction. This study was a first step to gain experience with telemedicine in the ED which has the potential to reduce PPE use in future pandemics or other patients with an indication for contact isolation.
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Affiliation(s)
- Bart G J Candel
- Department of Emergency Medicine, Máxima Medical Centre, Veldhoven, Noord-Brabant, The Netherlands
| | - Selma M M Vaes
- Department of Emergency Medicine, Máxima Medical Centre, Veldhoven, Noord-Brabant, The Netherlands
| | - Egid M van Bree
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Limburg, The Netherlands
| | - Sophie M A Groenen
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Limburg, The Netherlands
| | - Floor Derkx
- Department of Emergency Medicine, Máxima Medical Centre, Veldhoven, Noord-Brabant, The Netherlands
| | - Lisette A A Mignot
- Department of Emergency Medicine, Máxima Medical Centre, Veldhoven, Noord-Brabant, The Netherlands
| | - Bas de Groot
- Department of Emergency Medicine, Leiden University Medical Centre, Leiden, Zuid-Holland, The Netherlands
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Lo Bianco G, Di Pietro S, Mazzuca E, Imburgia A, Tarantino L, Accurso G, Benenati V, Vernuccio F, Bucolo C, Salomone S, Riolo M. Multidisciplinary Approach to the Diagnosis and In-Hospital Management of COVID-19 Infection: A Narrative Review. Front Pharmacol 2020; 11:572168. [PMID: 33362541 PMCID: PMC7758731 DOI: 10.3389/fphar.2020.572168] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 10/27/2020] [Indexed: 01/08/2023] Open
Abstract
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2 or COVID-19 disease) was declared a pandemic on 11th March 2020 by the World Health Organization. This unprecedented circumstance has challenged hospitals' response capacity, requiring significant structural and organizational changes to cope with the surge in healthcare demand and to minimize in-hospital risk of transmission. As our knowledge advances, we now understand that COVID-19 is a multi-systemic disease rather than a mere respiratory tract infection, therefore requiring holistic care and expertise from various medical specialties. In fact, the clinical spectrum of presentation ranges from respiratory complaints to gastrointestinal, cardiac or neurological symptoms. In addition, COVID-19 pandemic has created a global burden of mental illness that affects the general population as well as healthcare practitioners. The aim of this manuscript is to provide a comprehensive and multidisciplinary insight into the complexity of this disease, reviewing current scientific evidence on COVID-19 management and treatment across several medical specialties involved in the in-hospital care of these patients.
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Affiliation(s)
- Giuliano Lo Bianco
- Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, Catania, Italy
- Anesthesiology and Pain Department, Fondazione Istituto G.Giglio, Cefalù, Italy
| | - Santi Di Pietro
- Emergency Medicine Fellowship Programme, University of Pavia, Pavia, Italy
- Emergency Department, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Emilia Mazzuca
- Unità operativa Complessa di Pneumologia, A.O. Ospedali Riuniti Villa Sofia Cervello, Palermo, Italy
| | | | - Luca Tarantino
- Cliniche Humanitas Gavazzeni, U.O. Elettrofisiologia, Bergamo, Italy
| | - Giuseppe Accurso
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), Section of Anaesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Palermo, Italy
| | | | - Federica Vernuccio
- Section of Radiology, Department of Biomedicine, Neurosciences and Advanced Diagnostics (BIND), University of Palermo, Palermo, Italy
| | - Claudio Bucolo
- Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, Catania, Italy
| | - Salvatore Salomone
- Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, Catania, Italy
| | - Marianna Riolo
- Struttura Complessa di Neurologia, Ospedale Santa Croce di Moncalieri, Asl TO5, Moncalieri (TO), Italy
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Tsai MJ, Tsai WT, Pan HS, Hu CK, Chou AN, Juang SF, Huang MK, Hou MF. Deployment of information technology to facilitate patient care in the isolation ward during COVID-19 pandemic. J Am Med Inform Assoc 2020; 27:1819-1820. [PMID: 32516374 PMCID: PMC7314018 DOI: 10.1093/jamia/ocaa126] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 05/27/2020] [Accepted: 06/08/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ming-Ju Tsai
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Internal Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Superintendent, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Tsung Tsai
- Department of Medical Information, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hui-Sheng Pan
- Department of Medical Information, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chia-Kuei Hu
- Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - An-Ni Chou
- Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shian-Fei Juang
- Department of Medical Information, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Kuo Huang
- Department of Superintendent, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Feng Hou
- Department of Superintendent, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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