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Barbosa IDS, Jaques AE, Radovanovic CAT, Andrade LD, Dermatte LPG, Souza CMD, Tonon MM. Development of a mobile application for emergency shift handovers using the National Early Warning Score. Rev Gaucha Enferm 2023; 44:e20220130. [PMID: 37729267 DOI: 10.1590/1983-1447.2023.20220130.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 03/08/2023] [Indexed: 09/22/2023] Open
Abstract
OBJECTIVE To develop and validate a prototype of a mobile application shift handover between nurses in the emergency room using a severity scale. METHOD This is a technological tool carried out at the Universidade Estadual de Maringá using design thinking, divided into four phases: discovering, defining, developing, and delivering. To structure the information, a checklist was used based on the Situation Background Assessment Recommendation, and to categorize patients in terms of severity, the National Early Warning Score was used. The validation of the sample was carried out by 10 nurses, specialized in the field of urgency and emergency, using the System Usability Scale questionnaire to assess usability. The content validity coefficient was used for analysis. RESULTS The application scored 75.75 in usability and had a content validity coefficient of 0.8. CONCLUSION The prototype obtained an excellent evaluation of usability and agreement between evaluators. Future studies are needed for implementation in practice, evaluating the practicality, applicability, efficiency and time savings in shift information transfer.
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Affiliation(s)
- Iran Dos Santos Barbosa
- Universidade Estadual de Maringá (UEM), Programa de Mestrado Profissional em Gestão, Tecnologia e Inovação em Urgência e Emergência. Maringá, Paraná, Brasil
| | - André Estevam Jaques
- Universidade Estadual de Maringá (UEM), Programa de Pós-Graduação em Enfermagem. Maringá, Paraná, Brasil
| | | | - Luciano de Andrade
- Universidade Estadual de Maringá (UEM), Programa de Pós-Graduação em Ciências da Saúde. Maringá, Paraná, Brasil
| | | | - Carla Moretti de Souza
- Universidade Estadual de Maringá (UEM), Programa de Pós-Graduação em Enfermagem. Maringá, Paraná, Brasil
| | - Martina Mesquita Tonon
- Universidade Estadual de Maringá (UEM), Programa de Pós-Graduação em Enfermagem. Maringá, Paraná, Brasil
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Rosenthal JL, Hoyt-Austin AE, Ketchersid A, Sanders A, Harper TA, Tancredi DJ, Young HM, Romano PS, Marcin JP. Nurse-to-family telehealth for pediatric transfers: protocol for a feasibility and pilot cluster randomized controlled trial. Pilot Feasibility Stud 2023; 9:57. [PMID: 37041600 PMCID: PMC10088172 DOI: 10.1186/s40814-023-01292-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 03/30/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND Children presenting to emergency departments of community hospitals may require transfer to a children's hospital for more definitive care, but the transfer process can be distressing and burdensome to patients, families, and the healthcare system. Using telehealth to bring the children's hospital nurse virtually to the bedside of the child in the emergency department has the potential to promote family-centered care and minimize triage issues and other transfer-associated burdens. To explore the feasibility of the nurse-to-family telehealth intervention, we are conducting a pilot study. METHODS This parallel cluster randomized controlled feasibility and pilot trial will randomize six community emergency departments to use either nurse-to-family telehealth (intervention) or usual care (control) for pediatric inter-facility transfers. All eligible children presenting to a participating site during the study period who require inter-facility transfer will be included. Eligibility requires that there be an English-speaking adult parent or guardian at the emergency department bedside. We will examine feasibility objectives that assess protocol assignment adherence, fidelity, and survey response rates. We will measure subject-level exploratory outcome data to test feasibility of data collection and to obtain effect size estimates; exploratory outcomes include family-centered care, family experience, parent acute stress, parent distress, and change in level of care. Additionally, we will conduct a mixed methods implementation evaluation using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. DISCUSSION The findings from this trial will increase our understanding about nurse-to-family telehealth during pediatric transfers. The mixed methods implementation evaluation will provide relevant insight about the contextual factors that influence the implementation and rigorous evaluation of our intervention. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05593900. First Posted: October 26, 2022. Last Update Posted: December 5, 2022.
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Affiliation(s)
- Jennifer L Rosenthal
- Department of Pediatrics, University of California Davis, 2516 Stockton Blvd, Sacramento, CA, 95817, USA.
- Center for Health and Technology, University of California Davis, 4610 X Street, Sacramento, CA, 95817, USA.
| | - Adrienne E Hoyt-Austin
- Department of Pediatrics, University of California Davis, 2516 Stockton Blvd, Sacramento, CA, 95817, USA
| | - Audriana Ketchersid
- Department of Pediatrics, University of California Davis, 2516 Stockton Blvd, Sacramento, CA, 95817, USA
| | - April Sanders
- Department of Pediatrics, University of California Davis, 2516 Stockton Blvd, Sacramento, CA, 95817, USA
| | - Thomas A Harper
- Center for Health and Technology, University of California Davis, 4610 X Street, Sacramento, CA, 95817, USA
| | - Daniel J Tancredi
- Department of Pediatrics, University of California Davis, 2516 Stockton Blvd, Sacramento, CA, 95817, USA
| | - Heather M Young
- Betty Irene Moore School of Nursing, University of California Davis, 2570 48Th St., Sacramento, CA, 95817, USA
| | - Patrick S Romano
- Department of Pediatrics, University of California Davis, 2516 Stockton Blvd, Sacramento, CA, 95817, USA
- Department of Internal Medicine and Center for Healthcare Policy and Research, University of California Davis, 4150 V St., Sacramento, CA, 95817, USA
| | - James P Marcin
- Department of Pediatrics, University of California Davis, 2516 Stockton Blvd, Sacramento, CA, 95817, USA
- Center for Health and Technology, University of California Davis, 4610 X Street, Sacramento, CA, 95817, USA
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Marcin JP, Sauers-Ford HS, Mouzoon JL, Haynes SC, Dayal P, Sigal I, Tancredi D, Lieng MK, Kuppermann N. Impact of Tele-Emergency Consultations on Pediatric Interfacility Transfers: A Cluster-Randomized Crossover Trial. JAMA Netw Open 2023; 6:e2255770. [PMID: 36780158 PMCID: PMC9926323 DOI: 10.1001/jamanetworkopen.2022.55770] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
IMPORTANCE Pediatric referral centers are increasingly using telemedicine to provide consultations to help care for acutely ill children presenting to rural and community emergency departments (EDs). These pediatric telemedicine consultations may help improve physician decision-making and may reduce the frequency of overtriage and interfacility transfers. OBJECTIVE To examine the use of pediatric critical care telemedicine vs telephone consultations associated with risk-adjusted transfer rates of acutely ill children from community and rural EDs. DESIGN, SETTING, AND PARTICIPANTS A cluster-randomized crossover trial was conducted between November 18, 2015, and March 26, 2018. Analyses were conducted from January 19, 2018, to July 23, 2022, 2022. Participants included acutely ill children aged 14 years and younger presenting to a participating ED in 15 rural and community EDs in northern California. INTERVENTIONS Participating EDs were randomized to use telemedicine or telephone for consultations with pediatric critical care physicians according to 1 of 4 unbalanced (3 telemedicine:1 telephone) crossover treatment assignment sequences. MAIN OUTCOMES AND MEASURES Intention-to-treat, treatment-received, and per-protocol analyses were performed to determine the risk of transfer using mixed effects Poisson regression analyses with random intercepts for presenting EDs to account for hospital-level clustering. RESULTS A total of 696 children (392 boys [56.3%]; mean [SD] age, 4.2 [4.6] years) were enrolled. Of the 537 children (77.2%) assigned to telemedicine, 251 (46.7%) received the intervention. In the intention-to-treat analysis, patients assigned to the telemedicine arm were less likely to be transferred compared with patients assigned to the telephone arm after adjusting for patient age, severity of illness, and hospital study period (risk rate [RR], 0.93; 95% CI, 0.88-0.99). The adjusted risk of transfer was significantly lower in the telemedicine arm compared with the telephone arm in both the treatment-received analysis (RR, 0.81; 95% CI, 0.71-0.94) and the per-protocol analysis (RR, 0.79; 95% CI, 0.68-0.92). CONCLUSIONS AND RELEVANCE In this randomized trial, the use of telemedicine to conduct consultations for acutely ill children in rural and community EDs resulted in less frequent overall interfacility transfers than consultations done by telephone. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02877810.
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Affiliation(s)
- James P. Marcin
- Department of Pediatrics, University of California, Davis School of Medicine, Sacramento
| | - Hadley S. Sauers-Ford
- Department of Pediatrics, University of California, Davis School of Medicine, Sacramento
| | - Jamie L. Mouzoon
- Department of Pediatrics, University of California, Davis School of Medicine, Sacramento
| | - Sarah C. Haynes
- Department of Pediatrics, University of California, Davis School of Medicine, Sacramento
| | - Parul Dayal
- Genentech Inc, South San Francisco, California
| | - Ilana Sigal
- Department of Pediatrics, University of California, Davis School of Medicine, Sacramento
| | - Daniel Tancredi
- Department of Pediatrics, University of California, Davis School of Medicine, Sacramento
| | - Monica K. Lieng
- Department of Pediatrics, University of California, Davis School of Medicine, Sacramento
| | - Nathan Kuppermann
- Department of Pediatrics, University of California, Davis School of Medicine, Sacramento
- Department of Emergency Medicine, University of California, Davis School of Medicine, Sacramento
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Rosenthal JL, Ketchersid A, Horath E, Sanders A, Harper TA, Hoyt-Austin AE, Haynes SC. Using human-centered design to develop a nurse-to-family telehealth intervention for pediatric transfers. Digit Health 2023; 9:20552076231219123. [PMID: 38107976 PMCID: PMC10725135 DOI: 10.1177/20552076231219123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/20/2023] [Indexed: 12/19/2023] Open
Abstract
Objective To develop a nurse-to-family telehealth intervention for pediatric inter-facility transfers using the human-centered design approach. Methods We conducted the inspiration and ideation phases of a human-centered design process from July 2022 to December 2022. For the inspiration phase, we conducted a qualitative cross-sectional case study design over 3 months. We used thematic analysis with the framework approach of parent and provider interviews. Five team members individually coded transcripts and then met to discuss memos, update a construct summary sheet, and identify emerging themes. The team adapted themes into "How Might We" statements. For the ideation phase, multidisciplinary stakeholders brainstormed solutions to the "How Might We" statements in a design workshop. Workshop findings informed the design of a nurse-to-family telehealth intervention, which was iteratively revised over 2 months based on stakeholder feedback sessions. Results We conducted interviews with nine parents, 11 nurses, and 13 physicians. Four themes emerged supporting the promise of a nurse-to-family telehealth intervention, the need to effectively communicate the intervention purpose, the value of a user-friendly workflow, and the essentiality of ensuring that diverse populations equitably benefit from the intervention. "How Might We" statements were discussed among 22 total workshop participants. Iterative adaptations were made to the intervention until feedback from workshop participants and 67 other stakeholders supported no further improvements were needed. Conclusion Human-centered design phases facilitated stakeholder engagement in developing a nurse-to-family telehealth intervention. This intervention will be tested in an implementation phase as a feasibility and pilot trial.
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Affiliation(s)
- Jennifer L Rosenthal
- Department of Pediatrics, University of California Davis, Sacramento, CA, USA
- Center for Health and Technology, University of California Davis, Sacramento, CA, USA
| | - Audriana Ketchersid
- Department of Pediatrics, University of California Davis, Sacramento, CA, USA
| | - Elva Horath
- Department of Pediatrics, University of California Davis, Sacramento, CA, USA
| | - April Sanders
- Department of Pediatrics, University of California Davis, Sacramento, CA, USA
| | - Thomas A Harper
- Center for Health and Technology, University of California Davis, Sacramento, CA, USA
| | | | - Sarah C Haynes
- Department of Pediatrics, University of California Davis, Sacramento, CA, USA
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Azzuqa A, Chuo J, Zenge J. Tele-medicine: Innovative tools for a safe transition to home in neonatal care. Semin Perinatol 2021; 45:151427. [PMID: 34006383 DOI: 10.1016/j.semperi.2021.151427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Abeer Azzuqa
- Division of Newborn Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine and UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - John Chuo
- Department of Neonatology, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jeanne Zenge
- Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine and Children's Hospital of Colorado, Denver, Colorado, USA
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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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Nawas MT, Landau HJ, Sauter CS, Featherstone CA, Kenny SA, Rodriguez ES, Johnson LG, Giralt SA, Scordo M. Pilot Study of Telehealth Evaluations in Patients Undergoing Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2020; 26:e135-e137. [PMID: 32070723 DOI: 10.1016/j.bbmt.2020.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 02/03/2020] [Accepted: 02/06/2020] [Indexed: 10/25/2022]
Abstract
Telehealth involves the use of telecommunication and information technology for the delivery of clinical care and may be a mechanism to alleviate the burden of visits faced by patients undergoing hematopoietic cell transplantation (HCT). Few studies have evaluated the feasibility and acceptability of telehealth visits in the care of HCT patients. We conducted 27 telehealth visits with 25 patients undergoing HCT using a videoconferencing system that allows for real-time, 2-way interactions and administered satisfaction surveys to patients and providers. Of the 25 patients included in the study, 20 (80%) and 5 (20%) were undergoing autologous and allogeneic HCT, respectively. The telehealth visits were distributed as follows: 3 inpatient visits upon admission for HCT; 11 inpatient visits between 2 and 14 days post-HCT; 4 inpatient visits prior to discharge after HCT; 8 outpatient, post-HCT follow-up visits; and 1 handoff to a community oncologist. Out of a total of 54 provider assessments, 7 providers (13%) were unable to complete some part of the physical examination, but no provider reported being unable to manage patients' symptoms through telehealth. Eighty-one percent of patients were either satisfied or very satisfied with the telemedicine session. Overall satisfaction was higher among patients than providers (mean scores 4.12 versus 2.64; scale 1 to 5, with 1 = very poor to 5 = excellent). Technological barriers resulting in delays and suboptimal physical examination were largely responsible for provider dissatisfaction. The use of telehealth to deliver comprehensive follow-up care to HCT patients is feasible across different HCT types but is dependent upon quality of data streaming and videoconferencing technologies.
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Affiliation(s)
- Mariam T Nawas
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Heather J Landau
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Craig S Sauter
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Catherine A Featherstone
- Division of Advanced Practice Providers, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sheila A Kenny
- Division of Advanced Practice Providers, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Lauren G Johnson
- Office of Nursing Research, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sergio A Giralt
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Michael Scordo
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
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Nursing Handoffs in the PICU: Is Telemedicine Making It Better? Pediatr Crit Care Med 2019; 20:890-891. [PMID: 31483381 DOI: 10.1097/pcc.0000000000002020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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