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Hoffman B, Braund H, McKeown S, Dalgarno N, Godfrey C, Appireddy R. Telemedicine and medical education: a mixed methods systematic review protocol. JBI Evid Synth 2022; 20:3045-3057. [PMID: 35946805 DOI: 10.11124/jbies-21-00481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The objective of this review is to synthesize and appraise the available research on educational strategies required to prepare medical learners for engaging in telemedicine and virtual care. INTRODUCTION The COVID-19 pandemic has resulted in significant uptake of virtual care and telemedicine, highlighting the growing need for health care organizations and medical institutions to support physicians and learners navigating this new model of health care delivery, clinical learning, and assessment. Developing a better understanding of how best to prepare medical trainees across the continuum of undergraduate, postgraduate, and continuing professional development to engage in virtual care is critical in ensuring our continued ability to meet educational mandates and provide ambulatory care that is safe, efficient, and timely. INCLUSION CRITERIA Eligible studies will include medical learners who receive education on how to deliver telemedicine. The quantitative component of the review will compare learners exposed to educational interventions with learners not exposed to an intervention, or to a different intervention. Outcomes will include competencies in telemedicine delivery, knowledge, and behaviors. The qualitative component of the review will explore learners' experiences with the delivery of educational strategies that address telemedicine. METHODS Embase, MEDLINE, Evidence-Based Medicine Reviews: Cochrane Central Register of Controlled Trials, Web of Science Core Collection, Education Source, and ProQuest Dissertations and Theses Global will be searched to identify published and unpublished studies. No date or language restrictions will be applied. This systematic review will be conducted in accordance with the JBI methodology for mixed methods systematic reviews using a convergent segregated approach. Titles and abstracts of potential studies will be screened, and potentially relevant studies will undergo full-text review for eligibility and critical appraisal of the study methodology. Data will be extracted from those studies selected for inclusion. Findings will be described relating to the effectiveness of educational curricula, initiatives, and best practices in trainee engagement in telemedicine and virtual care. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42021264332.
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Affiliation(s)
- Bryn Hoffman
- Office of Professional Development and Educational Scholarship, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada.,School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Heather Braund
- Office of Professional Development and Educational Scholarship, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Sandra McKeown
- Bracken Health Sciences Library, Queen's University, Kingston, ON, Canada
| | - Nancy Dalgarno
- Office of Professional Development and Educational Scholarship, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Christina Godfrey
- Queen's Collaboration for Health Care Quality: A JBI Centre of Excellence, Queen's University School of Nursing, Queen's University, Kingston, ON, Canada
| | - Ramana Appireddy
- Faculty of Health Sciences, Queen's University; Division of Neurology, Department of Medicine, School of Medicine, Queen's University, Kingston, ON, Canada
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Bouamra B, Chakroun K, Medeiros De Bustos E, Dobson J, Rouge JA, Moulin T. Simulation-Based Teaching of Telemedicine for Future Users of Teleconsultation and Tele-Expertise: Feasibility Study. JMIR MEDICAL EDUCATION 2021; 7:e30440. [PMID: 34941553 PMCID: PMC8734919 DOI: 10.2196/30440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 09/20/2021] [Accepted: 09/20/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Health care professionals worldwide are increasingly using telemedicine in their daily clinical practice. However, there is still a lack of dedicated education and training even though it is needed to improve the quality of the diverse range of telemedicine activities. Simulation-based training may be a useful tool in telemedicine education and training delivery. OBJECTIVE This study aims to assess the feasibility and acceptability of simulation-based telemedicine training. METHODS We assessed five telemedicine training sessions conducted in a simulation laboratory. The training was focused on video teleconsultations between a patient and a health care professional. The assessment included the participants' satisfaction and attitudes toward the training. RESULTS We included 29 participants in total. Participant satisfaction was high (mean score 4.9 of 5), and those that took part stated the high applicability of the simulation-based training to their telemedicine practices (mean score 4.6 of 5). They also stated that they intended to use telemedicine in the future (mean score 4.5 of 5). CONCLUSIONS Simulation-based training of telemedicine dedicated to video teleconsultation was feasible and showed high satisfaction from participants. However, it remains difficult to scale for a high number of health care professionals.
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Affiliation(s)
- Benjamin Bouamra
- Department of Neurology, Besançon University Hospital, Besançon, France
| | - Karim Chakroun
- Department of Neurology, Besançon University Hospital, Besançon, France
| | | | - Jennifer Dobson
- Department of Neurology, Besançon University Hospital, Besançon, France
| | - Jeanne-Antide Rouge
- Faculty of Medicine, University of Franche-Comté MedSim Laboratory, Besançon, France
| | - Thierry Moulin
- Department of Neurology, Besançon University Hospital, Besançon, France
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Brown CW, Elofuke P. Multiperspective simulations for implementing a change in service: stroke telethrombolysis. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2021; 7:624-626. [DOI: 10.1136/bmjstel-2020-000848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 05/28/2021] [Indexed: 11/04/2022]
Abstract
Simulation-based training has been used in a variety of ways to demonstrate and improve process elements of patient care. One example of this is in improving door-to-needle times in hyperacute stroke care. Changes in service by one team which affect another bring difference of opinions between service providers involved and can lead to interdepartmental conflict. In this report, we use Kurt Lewin’s model for change to describe how a series of multiperspective simulation-based exercises were used in implementing a change in practice with the introduction of telethrombolysis within a large tertiary stroke referral hospital. The use of multiperspective or bidirectional simulation allowed a ‘meeting of minds’ with each service able to illustrate key themes to the other service. This was demonstrated through a series of simulation-based exercises. Following successful simulation-based exercises and subsequent interdepartmental agreement, a telethrombolysis pilot has been conducted within our centre. Ongoing audit of practice continues as this method of treatment delivery is continued. Further simulation work is planned as a national thrombectomy service is instigated.
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Casolla B, de Leciñana MA, Neves R, Pfeilschifter W, Svobodova V, Jung S, Kemmling A, Mikulik R, Santalucia P. Simulation training programs for acute stroke care: Objectives and standards of methodology. Eur Stroke J 2021; 5:328-335. [PMID: 33598550 DOI: 10.1177/2396987320971105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 10/09/2020] [Indexed: 01/22/2023] Open
Abstract
The European Stroke Organisation (ESO) Simulation Committee was established in 2017 with the intent to promote simulation education and training in the stroke field. The application of simulation methodology in education and training improves healthcare professional performances in real clinical practice and patient outcomes. We evaluated the implementation of simulation training in stroke medicine, how it can significantly affect stroke pathways and quality of care. We herewith describe simulation techniques in the acute stroke setting. Simulation programs place the trainees in a safe environment, allowing both role-playings for decision making training and procedural simulation for technical skills improvement. This paper includes the position of the Committee on the key points, principles, and steps in order to set up and promote simulation programs in European stroke centers. Stroke is an emergency, and hyperacute phase management requires knowledge, expertise, optimal multidisciplinary team working, and timely actions in a very narrow time window. The ESO Simulation Committee promotes the implementation of simulation training in stroke care according to a specific and validated methodology.
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Affiliation(s)
- Barbara Casolla
- Department of Neurology, Stroke Unit, Univ. Lille, Inserm U1172, CHU Lille, Lille, France
| | - Maria Alonso de Leciñana
- Department of Neurology, Stroke Center, University Hospital La Paz, Universidad Autónoma, Madrid, Spain
| | - Raquel Neves
- Royal Heath Group Czech Rehabilitation Hospital, Abu Dhabi, United Arab Emirates
| | - Waltraud Pfeilschifter
- Department of Neurology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Veronica Svobodova
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - Simon Jung
- Department of Neurology, University Hospital of Bern, Bern, Switzerland
| | - André Kemmling
- Department of Neuroradiology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Robert Mikulik
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic.,Neurology Department, St. Anne's University Hospital and Masaryk University, Brno, Czech Republic
| | - Paola Santalucia
- Department of Neurology and Strategic Direction, Azienda Sanitaria Provinciale di Ragusa, Ragusa, Italy
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Schinasi DA, Atabaki SM, Lo MD, Marcin JP, Macy M. Telehealth in pediatric emergency medicine. Curr Probl Pediatr Adolesc Health Care 2021; 51:100953. [PMID: 33551336 DOI: 10.1016/j.cppeds.2021.100953] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Modern technologies and contemporary clinical practice have set the stage for the integration of telehealth into existing models of healthcare. These models of telehealth care offer novel opportunities for advancing pediatric emergency care. In this manuscript, we introduce applications of telehealth in pediatric emergency medicine (PEM) with the pediatric emergency department (ED) both as originating site and distant site. We present barriers to adoption, implementation, and sustaining PEM telehealth programs, as well as strategies to overcome those. We discuss cost and finances as well as policy considerations and implications. Lastly, we review strategies for evaluation to assess program impact and ensure sustainability.
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Affiliation(s)
- Dana A Schinasi
- Department of Pediatrics, Division of Emergency Medicine, Northwestern University Feinberg School of Medicine, United States; Telehealth Programs, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 East Chicago Avenue, Box 32, Chicago, IL 60611-2605, United States.
| | - Shireen M Atabaki
- Division of Emergency Medicine, Telemedicine Program, Children's National Medical Center, Washington, DC, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - Mark D Lo
- Department of Pediatrics, Division of Emergency Medicine, University of Washington School of Medicine, United States; Telehealth Center, Seattle Children's Hospital, United States
| | - James P Marcin
- Department of Pediatrics, Division of Critical Care Medicine, University of California Davis School of Medicine, United States
| | - Michelle Macy
- Department of Pediatrics, Division of Emergency Medicine, Northwestern University Feinberg School of Medicine, United States; Telehealth Programs, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 East Chicago Avenue, Box 32, Chicago, IL 60611-2605, United States; Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Ann & Robert H. Lurie Children's Hospital of Chicago, United States
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Telemedicine and Distance Learning for Obstetrician/Gynecologist Provider Education. Obstet Gynecol Clin North Am 2020; 47:353-362. [PMID: 32451023 DOI: 10.1016/j.ogc.2020.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Tele-education is the use of communications technologies to distribute knowledge from one health care provider to another when distance separates providers. At the University of Arkansas for Medical Sciences, tele-education has been used for more than two decades to educate and support rural obstetrician/gynecologists throughout the state. Tele-education at University of Arkansas for Medical Sciences incorporates numerous interactive videoconferences and other digital portals and platforms. Continued provider education through tele-education increases access to quality care and evidenced-based practices for rural populations and is an effective strategy in the battle against health care disparities.
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Morris NA, Czeisler BM, Sarwal A. Simulation in Neurocritical Care: Past, Present, and Future. Neurocrit Care 2020; 30:522-533. [PMID: 30361865 DOI: 10.1007/s12028-018-0629-2] [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] [Indexed: 10/28/2022]
Abstract
Simulation-based medical education is a technique that leverages adult learning theory to train healthcare professionals by recreating real-world scenarios in an interactive way. It allows learners to emotionally engage in the assessment and management of critically ill patients without putting patients at risk. Learners are encouraged to work at the edge of their expertise to promote growth and are provided with feedback to nurture development. Thus, the training is targeted to the learner, not the patient. Despite its origins as a teaching tool for neurological diseases, simulation-based medical education has been historically abandoned by neurocritical care educators. In contrast, other critical care educators have embraced the technique and built an impressive foundation of literature supporting its use. Slowly, neurocritical care educators have started experimenting with simulation-based medical education and sharing their results. In this review, we will investigate the historical origins of simulation in the neurosciences, the conceptual framework supporting the technique, current applications, and future directions.
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Affiliation(s)
- Nicholas A Morris
- Department of Neurology, Program in Trauma, University of Maryland School of Medicine, Baltimore, MD, USA. .,Division of Neurocritical Care and Emergency Neurology, University of Maryland Medical Center, 22 S. Greene St, G7K18, Baltimore, MD, 21201, USA.
| | - Barry M Czeisler
- Departments of Neurology and Neurosurgery, New York University School of Medicine, New York, NY, USA
| | - Aarti Sarwal
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Sweid A, Atallah E, Saad H, Bekelis K, Chalouhi N, Dang S, Li J, Kumar A, Turpin J, Barsoom R, Tjoumakaris S, Hasan D, DePrince M, Labella G, Rosenwasser RH, Jabbour P. Correlation between pre-admission blood pressure and outcome in a large telestroke cohort. J Clin Neurosci 2019; 62:33-37. [PMID: 30660477 DOI: 10.1016/j.jocn.2019.01.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 01/03/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND Telemedicine rapidly connects patients, with acute ischemic stroke symptoms, with neurovascular specialists for assessment to reduce chemical thrombolysis delivery times. Management of AIS includes maintaining target systolic blood pressures (SBP). In this retrospective study, we assess the efficacy of the telestroke (TS) system at a primary stroke center and the prognostic value of SBP throughout the transportation process. METHODS Patients presenting with acute-onset neurological symptoms to the TS hospitals network, over a 5-year period, were assessed. Those with a confirmed diagnosis of AIS were included. We examined demographics, presenting-NIHSS, last SBP before transfer from the network hospital and continuous BP during transport, stroke risk factors, hospital-course, door-to-needle (DTN) time, treatments, and modified Rankin Scale(mRS). Multivariate analysis was conducted to evaluate the prognostic value of SBP on stroke outcome. RESULTS Of 2,928 patients identified, 1,353 were diagnosed with AIS. Mean age was 66.6 years (SD = 15.4), 47.6% female. Most cases affected the MCA(44.5%). Mean presenting-NIHSS was 8.67(SD = 8.38) and mean SBP was 148 mmHg(SD = 25.39). 73.2% treated using a standard protocol, 23.7% given IVrt-PA, and 6.8% received mechanical thrombectomy(MT). Mean DTN was 96 min(SD = 46; 27.3% <60 min). Age, presenting-NIHSS and pre-existing hypertension were associated with higher mortality and/or higher mRS. SBP was not associated with higher mortality and morbidity. CONCLUSIONS This study displays better clinical outcomes at latest follow-up when compared to current international TS studies. SBP during transportation to the hub hospital did not prove to be a useful prognostic metric. However, future studies should address the limitations of this study to confirm these findings.
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Affiliation(s)
- Ahmad Sweid
- Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United States.
| | - Elias Atallah
- Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United States.
| | - Hassan Saad
- Department of Neurological Surgery, Arkansas Neurosciences Institute, Little Rock, AR, United States
| | - Kimon Bekelis
- Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United States
| | - Nohra Chalouhi
- Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United States.
| | - Sophia Dang
- Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United States.
| | - Jonathan Li
- Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United States.
| | - Ayan Kumar
- Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United States.
| | - Justin Turpin
- Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United States.
| | - Randa Barsoom
- Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United States.
| | - Stavropoula Tjoumakaris
- Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United States.
| | - David Hasan
- Department of Neurological Surgery, University of Iowa, Department of Neurosurgery, Iowa City, IA, United States.
| | - Maureen DePrince
- Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United States.
| | - Giuliana Labella
- Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United States.
| | - Robert H Rosenwasser
- Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United States.
| | - Pascal Jabbour
- Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United States.
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Yaghobian S, Ohannessian R, Mathieu-Fritz A, Moulin T. National survey of telemedicine education and training in medical schools in France. J Telemed Telecare 2019; 26:303-308. [PMID: 30602352 DOI: 10.1177/1357633x18820374] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Telemedicine is a remote medical practice using information communication technology (ICT), and has been increasing in France since 2009. With all new forms of medical practice, education and training (ET) is required for quality and safety. To date, implementation of telemedicine ET has not been assessed in France. The objective of this study was to describe the implementation of telemedicine ET and evaluate the knowledge, attitudes and practices (KAP) of deans and associate deans from all medical schools in France. METHODS A cross-sectional non-mandatory, descriptive online survey with a self-administered questionnaire was performed from 15 November to 6 December, 2017. Respondents were accessed through the 'Conférence des doyens des Facultés de médecine'. RESULTS There were 48 respondents with a 47.4% response rate among deans. Telemedicine ET was limited in France; 10.4% in 1st year medicine (PACES); 4% in the final 3 years of medical school (D.F.A.S.M.) and 18.8% in medical residency. Emergency medicine, dermatology, radiology, neurology and geriatrics were specialties with implemented telemedicine training during residency. Of all respondents, 90% expressed a need to increase telemedicine ET, among which 75% accepted external support. A highly positive attitude towards telemedicine practice was reflected by 60.4% of respondents, and 56.2% practiced telemedicine at least once. DISCUSSION This study was the first to assess national telemedicine ET implementation in France. Telemedicine was integrated into initial medical education; however, telemedicine ET remains limited despite the positive attitudes of deans and associate deans. Further research would need to be conducted on telemedicine ET implementation and KAP of medical students and residents.
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Affiliation(s)
| | - Robin Ohannessian
- Télémédecine 360, TLM360, Paris, France.,French Society of Telemedicine, SFTelemed, France
| | - Alexandre Mathieu-Fritz
- French Society of Telemedicine, SFTelemed, France.,Université Paris-Est Marne-la-Vallée, LATTS (UMR CNRS 8134) 5, boulevard Descartes, Champs-sur-Marne, 77454 Marne-la-Vallée cedex 2, France
| | - Thierry Moulin
- French Society of Telemedicine, SFTelemed, France.,Department of Neurology 2, CHRU, Besançon- EA 481- University of Bourgogne Franche Comté, Besançon, France
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Pruvo JP, Berge J, Kuchcinski G, Bretzner M, Leclerc X, Hacein-Bey L. Health Care Organization for the Management of Stroke. Neuroimaging Clin N Am 2018; 28:691-698. [DOI: 10.1016/j.nic.2018.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Rockwell KL, Gilroy A. Emergency Telemedicine: Achieving and Maintaining Compliance with the Emergency Medical Treatment and Labor Act. Telemed J E Health 2018; 24:934-937. [PMID: 29652624 DOI: 10.1089/tmj.2017.0204] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Telemedicine is a growing and important platform for medical delivery in the emergency department. Emergency telemedicine outlays often confront and conflict with important federal healthcare regulations. Because of this, academic medical centers, critical access hospitals, and other providers interested in implementing emergency telemedicine have often delayed or forgone such services due to reasonable fears of falling out of compliance with regulatory restrictions imposed by the Emergency Medical Treatment and Labor Act ("EMTALA"). This article offers insights into methods for implementing emergency telemedicine services while maintaining EMTALA compliance. METHODOLOGY Critical analysis of EMTALA and its attendant regulations. RESULTS The primary means of ensuring EMTALA compliance while implementing emergency telemedicine programs include incorporating critical clinical details into the services contracts and implementing robust written policies that anticipate division of labor issues, the need for backup coverage, triaging, patient transfer protocols, and credentialing issues. With adequate up-front due diligence and meaningful contracting, hospitals and telemedicine providers can avoid common EMTALA liability pitfalls.
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Mehta T, Strauss S, Beland D, Fortunato G, Staff I, Lee N. Stroke Simulation Improves Acute Stroke Management: A Systems-Based Practice Experience. J Grad Med Educ 2018; 10:57-62. [PMID: 29467974 PMCID: PMC5821008 DOI: 10.4300/jgme-d-17-00167.1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 06/27/2017] [Accepted: 09/17/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Literature on the effectiveness of simulation-based medical education programs for caring for acute ischemic stroke (AIS) patients is limited. OBJECTIVE To improve coordination and door-to-needle (DTN) time for AIS care, we implemented a stroke simulation training program for neurology residents and nursing staff in a comprehensive stroke center. METHODS Acute stroke simulation training was implemented for first-year neurology residents in July 2011. Simulations were standardized using trained live actors, who portrayed stroke vignettes in the presence of a board-certified vascular neurologist. A debriefing of each resident's performance followed the training. The hospital stroke registry was also used for retrospective analysis. The study population was defined as all patients treated with intravenous tissue plasminogen activator for AIS between October 2008 and September 2014. RESULTS We identified 448 patients meeting inclusion criteria. Simulation training independently predicted reduction in DTN time by 9.64 minutes (95% confidence interval [CI] -15.28 to -4.01, P = .001) after controlling for age, night/day shift, work week versus weekend, and blood pressure at presentation (> 185/110). Systolic blood pressure higher than 185 was associated with a 14.28-minute increase in DTN time (95% CI 3.36-25.19, P = .011). Other covariates were not associated with any significant change in DTN time. CONCLUSIONS Integration of simulation based-medical education for AIS was associated with a 9.64-minute reduction in DTN time.
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Riou-Comte N, Mione G, Humbertjean L, Brunner A, Vezain A, Lavandier K, Marchal S, Bracard S, Debouverie M, Richard S. Implementation and Evaluation of an Economic Model for Telestroke: Experience from Virtuall, France. Front Neurol 2017; 8:613. [PMID: 29209268 PMCID: PMC5701923 DOI: 10.3389/fneur.2017.00613] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 11/03/2017] [Indexed: 01/07/2023] Open
Abstract
Background Telestroke is recognized as a safe and time-efficient way of treating stroke patients. However, admission centers (spokes) are subject to financial charges which can make them reluctant to join the system. We implemented and assessed an economic model supporting our telestroke system, Virtuall, France, which includes one expert center (hub) and six spokes. Methods The model is based on payment for the expertise provided by the hub, distribution of charges related to telemedicine according to the fees perceived by the spokes, and transfer of patients between the spokes and the hub. We performed a cost–benefit analysis for all patients included in Virtuall from January 2014 to December 2015 to assess the economic balance in each center. Results 321 patients were prospectively included in the study. Application of the economic model resulted in overall financial balance with funding of a dedicated medical service in the hub, and reduced costs directly related to telestroke by an average of 10% in the spokes. The conditions generating the highest costs for the spokes were: a patient returning from the hub for re-hospitalization (mean cost of $1,995/patient); management of patients treated by intravenous thrombolysis without transfer to the hub (mean cost of $2,075/patient). The most favorable financial condition for the spokes remained simple transfer of patients to the hub and no return (mean cost of $329/patient). Conclusion We describe an economic model which can be applied to any telestroke system to ensure the optimal balance between hub and spoke centers.
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Affiliation(s)
- Nolwenn Riou-Comte
- Department of Neurology, Stroke Unit, University Hospital of Nancy, Nancy, France
| | - Gioia Mione
- Department of Neurology, Stroke Unit, University Hospital of Nancy, Nancy, France
| | - Lisa Humbertjean
- Department of Neurology, Stroke Unit, University Hospital of Nancy, Nancy, France
| | | | | | | | | | - Serge Bracard
- Department of Neuroradiology, University Hospital of Nancy, Nancy, France
| | - Marc Debouverie
- Department of Neurology, Stroke Unit, University Hospital of Nancy, Nancy, France
| | - Sébastien Richard
- Department of Neurology, Stroke Unit, University Hospital of Nancy, Nancy, France.,Centre d'Investigation Clinique Plurithématique CIC-P 1433, INSERM U1116, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
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Abstract
[This corrects the article DOI: 10.1097/MD.0000000000003291.][This corrects the article DOI: 10.1097/MD.0000000000003731.][This corrects the article DOI: 10.1097/MD.0000000000003791.][This corrects the article DOI: 10.1097/MD.0000000000003805.][This corrects the article DOI: 10.1097/MD.0000000000003827.][This corrects the article DOI: 10.1097/MD.0000000000003863.][This corrects the article DOI: 10.1097/MD.0000000000003878.][This corrects the article DOI: 10.1097/MD.0000000000003879.][This corrects the article DOI: 10.1097/MD.0000000000003884.][This corrects the article DOI: 10.1097/MD.0000000000003900.][This corrects the article DOI: 10.1097/MD.0000000000003513.][This corrects the article DOI: 10.1097/MD.0000000000003631.][This corrects the article DOI: 10.1097/MD.0000000000003644.][This corrects the article DOI: 10.1097/MD.0000000000003692.][This corrects the article DOI: 10.1097/MD.0000000000003701.][This corrects the article DOI: 10.1097/MD.0000000000003706.][This corrects the article DOI: 10.1097/MD.0000000000003712.][This corrects the article DOI: 10.1097/MD.0000000000003767.][This corrects the article DOI: 10.1097/MD.0000000000003781.][This corrects the article DOI: 10.1097/MD.0000000000003808.][This corrects the article DOI: 10.1097/MD.0000000000003831.][This corrects the article DOI: 10.1097/MD.0000000000003837.][This corrects the article DOI: 10.1097/MD.0000000000003839.][This corrects the article DOI: 10.1097/MD.0000000000003842.][This corrects the article DOI: 10.1097/MD.0000000000003843.][This corrects the article DOI: 10.1097/MD.0000000000003847.][This corrects the article DOI: 10.1097/MD.0000000000003848.][This corrects the article DOI: 10.1097/MD.0000000000003850.][This corrects the article DOI: 10.1097/MD.0000000000003861.][This corrects the article DOI: 10.1097/MD.0000000000003862.][This corrects the article DOI: 10.1097/MD.0000000000003864.][This corrects the article DOI: 10.1097/MD.0000000000003866.][This corrects the article DOI: 10.1097/MD.0000000000003871.][This corrects the article DOI: 10.1097/MD.0000000000003872.][This corrects the article DOI: 10.1097/MD.0000000000003880.][This corrects the article DOI: 10.1097/MD.0000000000003878.][This corrects the article DOI: 10.1097/MD.0000000000003873.][This corrects the article DOI: 10.1097/MD.0000000000003876.][This corrects the article DOI: 10.1097/MD.0000000000003879.][This corrects the article DOI: 10.1097/MD.0000000000003881.][This corrects the article DOI: 10.1097/MD.0000000000003884.][This corrects the article DOI: 10.1097/MD.0000000000003885.][This corrects the article DOI: 10.1097/MD.0000000000003888.][This corrects the article DOI: 10.1097/MD.0000000000003889.][This corrects the article DOI: 10.1097/MD.0000000000003891.][This corrects the article DOI: 10.1097/MD.0000000000003893.][This corrects the article DOI: 10.1097/MD.0000000000003894.][This corrects the article DOI: 10.1097/MD.0000000000003897.][This corrects the article DOI: 10.1097/MD.0000000000003899.][This corrects the article DOI: 10.1097/MD.0000000000003900.][This corrects the article DOI: 10.1097/MD.0000000000003901.][This corrects the article DOI: 10.1097/MD.0000000000003902.][This corrects the article DOI: 10.1097/MD.0000000000003903.][This corrects the article DOI: 10.1097/MD.0000000000003904.][This corrects the article DOI: 10.1097/MD.0000000000003908.][This corrects the article DOI: 10.1097/MD.0000000000003910.][This corrects the article DOI: 10.1097/MD.0000000000003912.][This corrects the article DOI: 10.1097/MD.0000000000003916.][This corrects the article DOI: 10.1097/MD.0000000000003917.][This corrects the article DOI: 10.1097/MD.0000000000003918.][This corrects the article DOI: 10.1097/MD.0000000000003920.][This corrects the article DOI: 10.1097/MD.0000000000003921.][This corrects the article DOI: 10.1097/MD.0000000000003923.][This corrects the article DOI: 10.1097/MD.0000000000003924.][This corrects the article DOI: 10.1097/MD.0000000000003925.][This corrects the article DOI: 10.1097/MD.0000000000003934.][This corrects the article DOI: 10.1097/MD.0000000000003941.][This corrects the article DOI: 10.1097/MD.0000000000003944.][This corrects the article DOI: 10.1097/MD.0000000000003970.].
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