Experiences with the quality of telemedical care in an offshore setting - a qualitative study

BACKGROUND

The evaluation and the improvement of the quality of telemedical care become increasingly important in times where this type of care is offered to a broad number of patients more and more. As telemedical care in an offshore setting has already been in use for decades, analyzing the extensive experience of offshore paramedics using telemedical care can help identify determinants of quality. Therefore, the aim of this study was to explore determinants of the quality of telemedical care using the experiences of experienced offshore paramedics.

METHODS

We conducted a qualitative analysis of 22 semi-structured interviews with experienced offshore paramedics. The results were categorized in a hierarchical category system using content analysis as described by Mayring.

RESULTS

All 22 participants were males, having a mean of 3.9 years of experience working with telemedicine support offshore. Generally, participants stated that for them telemedical interaction did not differ much from personal interaction. However, the offshore paramedics personality and way to communicate were mentioned to impact the quality of telemedical care as it influenced the way cases were presented. Furthermore, interviewees described it to be impossible to use telemedicine in cases of an emergency as it was too time-consuming, technically too complex, and lead to cognitive overload as other tasks with higher priority needed their attention. Three determinants of a successful consultation were mentioned: low levels of complexity in the reason for consultation, telemedical guidance training for the teleconsultant physician and for the delegatee.

CONCLUSION

Appropriate indications for telemedical consultation, communication training of consultation partners, and the impact of personality need to be addressed to enhance the quality of future telemedical care.

From COVID-19 Pandemic to Patient Safety: A New “Spring” for Telemedicine or a Boomerang Effect?

During the Covid-19 health emergency, telemedicine was an essential asset through which health systems strengthened their response during the critical phase of the pandemic. According to the post-pandemic economic reform plans of many countries, telemedicine will not be limited to a tool for responding to an emergency condition but it will become a structural resource that will contribute to the reorganization of Healthcare Systems and enable the transfer of part of health care from the hospital to the home-based care. However, scientific evidences have shown that health care delivered through telemedicine can be burdened by numerous ethical and legal issues. Although there is an emerging discussion on patient safety issues related to the use of telemedicine, there is a lack of reseraches specifically designed to investigate patient safety. On the contrary, it would be necessary to determine standards and specific application rules in order to ensure safety. This paper examines the telemedicine-risk profiles and proposes a position statement for clinical risk management to support continuous improvement in the safety of health care delivered through telemedicine.

What is the acceptance of video consultations among orthopedic and trauma outpatients? A multi-center survey in 780 outpatients

INTRODUCTION

The purpose of the present study was to assess orthopedic and orthopedic trauma patients' willingness to perform hypothetical remote video consultations, possible advantages as well as concerns.

METHODS

Between June 2019 and November 2019, a survey amongst consecutive regular orthopedic and orthopedic trauma patients at the outpatient clinics from three European level I trauma centers was conducted via paper-based questionnaires, composed of participants` demographics as well as five open and closed questions. Participation was voluntary and anonymity was granted.

RESULTS

In total, 780 participants (female 302, 38.7%, male 478, 61.3%) with a mean age of 43.8 years (SD 17.1, range from 14 years to 94 years) were included. The majority of the participants (57,6%) were eager to use a remote consultation. Participants with an age of more than 55 years were significantly less likely to use a remote consultation than their younger counterparts (OR= 0.18, p=0.003. r²=0.141). Among the whole study population, 86.2% stated, that they had a device compatible with an online video consultation. The highest willingness to conduct a video consultation in respect of the participants` occupation was observed in "part-time"-jobs (70.6%), whereas the lowest disposition was seen in retired patients (37.1%) (p= 0.0001). The most stated reason why to conduct a video consultation was "communication of medical findings" (67.8%). The most stated advantage was the "reduction of physical consultations" (66.4%). "No physical examination" was the most frequently stated disadvantage (75.9%).

CONCLUSION

The majority of orthopedic and orthopedic trauma outpatients would use a video consultation, especially because of commuting and time issues and ideally to communicate medical findings, such as x-ray reports or lab values. Elderly patients appear to be less eager in regard to video consultations. These results may change for even better acceptance in view of a current pandemic situation, as experienced since early 2020. We feel that this assumption may warrant further investigation.

Perceptions of telecare training needs in home healthcare services: a focus group study

Background

The implementation and use of telecare requires significant changes to healthcare service organisation and delivery, including new ways of working for staff. Competency development and training for healthcare professionals is therefore required to enable necessary adaptation of clinical practice and ensure competent provision of telecare services. It is however unclear what skills healthcare staff need when providing care at a distance and there is little empirical evidence on effective training strategies for telecare practice. Training should however emphasise the experiences and preferences of prospective trainees to ensure its relevance to their educational needs. The aim of this study was to explore healthcare professionals’ perceptions of training related to the general use of telecare, and to identify specific training needs associated with the use of virtual visits in the home healthcare services.

Methods

Six focus group interviews were held with a total of 26 participants working in the home healthcare services in Norway, including registered nurses, enrolled nurses, physiotherapists, occupational therapists, social workers, health workers, and healthcare assistants. The data material was analysed by way of systematic text condensation.

Results

The analysis resulted in five categories relevant to telecare training for healthcare professionals: Purposeful training creates confidence and changes attitudes; Training needs depend on ability to cope with telecare; The timing of training; Training must facilitate practical insight into the patients’ perspective; and Training content must focus on the telecare process. Findings are discussed in light of implications for the form and content of a training program for healthcare professionals on how to undertake virtual home healthcare visits.

Conclusion

Appropriate preparation and training for telecare use is important for healthcare professionals and must be taken seriously by healthcare organisations. To facilitate the knowledge, skills and attitudes required for new ways of working and enable quality and safety in telecare practice, staff should be provided with training as part of telecare implementation processes. Telecare training should be hands-on and encourage an overall patient-centred approach to care to ensure good patient-professional relationships at a distance.

Technology in health care: forensic implications

Technology continues to evolve and improve making our everyday tasks appear sometimes routine and mundane. The health care industry has embraced technological advances to improve on its daily operations in an effort to run more efficiently. Health care providers must be aware that these technologies collect data, lots of data, which is discoverable and may be used to defend or refute your actions as a nurse. This article will take a closer look at health care technology, cell phones, medical equipment, social media, telematics, and Health Insurance Portability and Accountability Act requirements, so that you will become familiar with the information and electronic fingerprint left behind.

Patient safety risks associated with telecare: a systematic review and narrative synthesis of the literature

Background

Patient safety risk in the homecare context and patient safety risk related to telecare are both emerging research areas. Patient safety issues associated with the use of telecare in homecare services are therefore not clearly understood. It is unclear what the patient safety risks are, how patient safety issues have been investigated, and what research is still needed to provide a comprehensive picture of risks, challenges and potential harm to patients due to the implementation and use of telecare services in the home. Furthermore, it is unclear how training for telecare users has addressed patient safety issues. A systematic review of the literature was conducted to identify patient safety risks associated with telecare use in homecare services and to investigate whether and how these patient safety risks have been addressed in telecare training.

Methods

Six electronic databases were searched in addition to hand searches of key items, reference tracking and citation tracking. Strict inclusion and exclusion criteria were set. All included items were assessed according to set quality criteria and subjected to a narrative synthesis to organise and synthesize the findings. A human factors systems framework of patient safety was used to frame and analyse the results.

Results

22 items were included in the review. 11 types of patient safety risks associated with telecare use in homecare services emerged. These are in the main related to the nature of homecare tasks and practices, and person-centred characteristics and capabilities, and to a lesser extent, problems with the technology and devices, organisational issues, and environmental factors. Training initiatives related to safe telecare use are not described in the literature.

Conclusions

There is a need to better identify and describe patient safety risks related to telecare services to improve understandings of how to avoid and minimize potential harm to patients. This process can be aided by reframing known telecare implementation challenges and user experiences of telecare with the help of a human factors systems approach to patient safety.

Patients' Experiences with Specialist Care via Video Consultation in Primary Healthcare in Rural Areas

Introduction. Video consultation (VC) can improve access to specialist care, especially for individuals who live in rural areas that are long distances from specialist clinics. Aim. The aim of this study was to describe patients' experiences with specialist care via VC encounters. Method. Interviews were conducted with 26 patients who had participated in a VC encounter. The data were analysed using thematic content analysis. Result. The analysis resulted in two themes. The theme “confident with the technology” was constructed from the categories “possibilities and obstacles in using VC encounters” and “advantages and disadvantages of the technology.” The theme “personal satisfaction with the VC encounters” was constructed from the categories “support from the healthcare personnel,” “perceived security,” and “satisfaction with the specialist consultation.” Conclusion. The patients who did not think that the VC was the best care still considered that the visit was adequate because they did not have to travel. An important finding was that the patients' perceived even short distances to specialty care as expensive journeys because many patients had low incomes. Among the patients who had more than one VC, the second encounter was perceived as safer. Additionally, good communication was essential for the patient's perception of security during the VC encounter.

Envisioning patient safety in Telehealth: a research perspective

This article explores the need for research into patient safety in large-scale Telehealth systems faced with the perspective of its development extended to healthcare systems. Telehealth systems give rise to significant advantages in improving the quality of healthcare services as well as bringing about the possibility of new types of risk. A theoretical framework is proposed for patient safety for its approach as an emerging property in complex socio-technical systems (CSTS) and their modelling in layers. As regards this framework, the differential characteristic Telehealth elements of the system have been identified, with a greater emphasis on the level of Telehealth system and its typical subsystems. The bases of the analysis are based on references in the literature and the experience accumulated by the researchers in the area. In particular, a case describing an example of Telehealth to control patients undergoing treatment with oral anticoagulants is used. As a result, a series of areas of research into and topics regarding Telehealth patient safety are proposed to cover the detectable gaps. Both the theoretical and practical implications of the study are discussed and future perspectives are reflected on.