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Digby R, Kramer S, Yuan V, Ozavci G, Bucknall TK. Patients in isolation, their physical, environmental and mental health: An exploratory study. J Clin Nurs 2024. [PMID: 38887821 DOI: 10.1111/jocn.17295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 04/08/2024] [Accepted: 05/13/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Strict patient isolation in hospital is associated with adverse health outcomes. However, there is a lack of high-quality evidence for effective interventions to improve safety and quality of care for these patients. AIMS To identify patient reported areas for improvement in the care of patients in hospital isolation and to determine the feasibility of collecting patient reported outcomes using validated tools. METHODS Design An exploratory mixed methods study. Setting A major metropolitan teaching hospital in Melbourne, Australia. Participants Patients in hospital isolation for transmissible infections. Data collection Data were collected by (1) phone interviews with patients in isolation and (2) seven validated measurement tools to assess cognition, loneliness, nutritional status, quality of life, anxiety and depression and physical activity. Data were collected between September and December 2021. Data analysis Interviews were transcribed and analysed using thematic analysis. Quantitative data were analysed descriptively including participant characteristics and outcome data. RESULTS Participants identified areas for improvement including activities to decrease boredom, more contact with staff to mitigate loneliness and increase comfort care, and formalised communication about clinical treatment and discharge plan. Patients with gastrointestinal symptoms were happier to be alone. There were operational challenges within the health service including delays and miscommunication. Only 70% of the participants completed all questionnaires. CONCLUSION This study identified areas for improvement in care of patients in isolation and demonstrated that collecting patient reported outcomes using validated tools was feasible. The results of this research will inform development of an intervention to manage adverse effects. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Patients in hospital isolation require additional consideration to ensure that their needs are met to avoid adverse outcomes. The patient experience and comfort can be negatively affected when fundamental care is lacking. REPORTING METHOD (EQUATOR) EQUATOR guidelines for Mixed Methods Reporting in Rehabilitation & Health Sciences (MMR-RHS). PATIENT OR PUBLIC CONTRIBUTION Thirteen patients in hospital isolation agreed to participate in this study, sharing their experiences through interviews and assessment.
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Affiliation(s)
- Robin Digby
- Centre for Quality and Patient Safety, School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | - Sharon Kramer
- Centre for Quality and Patient Safety, School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | - Vicky Yuan
- Centre for Quality and Patient Safety, School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | - Guncag Ozavci
- Centre for Quality and Patient Safety, School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | - Tracey K Bucknall
- Centre for Quality and Patient Safety, School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
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Buba M, Dulude C, O'Donnell R, Rowan-Legg A, Sloan M, Nelson M, King WJ. Virtual family-centered rounds: a quality improvement initiative to adapt inpatient care during COVID-19 using a human-centred participatory design approach. BMC Pediatr 2023; 23:289. [PMID: 37312074 DOI: 10.1186/s12887-023-04091-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 05/23/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Family-centered rounds (FCR) are fundamental to pediatric inpatient care. During the COVID-19 pandemic, we aimed to design and implement a virtual family-centered rounds (vFCR) process that allowed continuation of inpatient rounds while following physical distancing guidelines and preserving personal protective equipment (PPE). METHODS A multidisciplinary team developed the vFCR process using a participatory design approach. From April through July 2020, quality improvement methods were used to iteratively evaluate and improve the process. Outcome measures included satisfaction, perceived effectiveness, and perceived usefulness of vFCR. Data were collected via questionnaire distributed to patients, families, staff and medical staff, and analyzed using descriptive statistics and content analysis. Virtual auditors monitored time per patient round and transition time between patients as balancing measures. RESULTS Seventy-four percent (51/69) of health care providers surveyed and 79% (26/33) of patients and families were satisfied or very satisfied with vFCR. Eighty eight percent (61/69) of health care providers and 88% (29/33) of patients and families felt vFCR were useful. Audits revealed an average vFCR duration of 8.4 min (SD = 3.9) for a single patient round and transition time between patients averaged 2.9 min (SD = 2.6). CONCLUSION Virtual family-centered rounds are an acceptable alternative to in-person FCR in a pandemic scenario, yielding high levels of stakeholder satisfaction and support. We believe vFCR are a useful method to support inpatient rounds, physical distancing, and preservation of PPE that may also be valuable beyond the pandemic. A rigorous process evaluation of vFCR is underway.
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Affiliation(s)
- Melanie Buba
- Department of Pediatrics, Division of Pediatric Medicine, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada.
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada.
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada.
| | - Catherine Dulude
- Department of Pediatrics, Division of Pediatric Medicine, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - Roisin O'Donnell
- Department of Pediatrics, Division of Pediatric Medicine, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
| | - Anne Rowan-Legg
- Department of Pediatrics, Division of Pediatric Medicine, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
| | - Megan Sloan
- Department of Pediatrics, Division of Pediatric Medicine, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - Matthew Nelson
- Department of Pediatrics, Division of Pediatric Medicine, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - W James King
- Department of Pediatrics, Division of Pediatric Medicine, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
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Abdolkhani R, Petersen S, Walter R, Zhao L, Butler-Henderson K, Livesay K. The Impact of Digital Health Transformation Driven by COVID-19 on Nursing Practice: Systematic Literature Review. JMIR Nurs 2022; 5:e40348. [PMID: 35867838 PMCID: PMC9431991 DOI: 10.2196/40348] [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: 06/16/2022] [Revised: 07/31/2022] [Accepted: 08/01/2022] [Indexed: 11/30/2022] Open
Abstract
Background The COVID-19 pandemic has accelerated the uptake of digital health innovations due to the availability of various technologies and the urgent health care need for treatment and prevention. Although numerous studies have investigated digital health adoption and the associated challenges and strategies during the pandemic, there is a lack of evidence on the impact on the nursing workforce. Objective This study aims to identify the impact of digital health transformation driven by COVID-19 on nurses. Methods The online software Covidence was used to follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. Relevant scientific health and computing databases were searched for papers published from January 2020 to November 2021. Using the 8D sociotechnical approach for digital health in health care systems, the papers were analyzed to identify gaps in applying digital health in nursing practice. Results In total, 21 papers were selected for content analysis. The analysis identified a paucity of research that quantifies the impact of the digital health transformation on nurses during the pandemic. Most of the initiatives were teleconsultation, followed by tele–intensive care unit (tele-ICU), and only 1 (5%) study explored electronic medical record (EMR) systems. Among the sociotechnical elements, the human-related factor was the most explored and the system measurement was the least studied item. Conclusions The review identified a significant gap in research on how implementing digital health solutions has impacted nurses during the COVID-19 pandemic. This gap needs to be addressed by further research to provide strategies for empowering the nursing workforce to be actively involved in digital health design, development, implementation, use, and evaluation.
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Affiliation(s)
- Robab Abdolkhani
- School of Health and Biomedical Sciences, Science, Technology, Engineering, and Mathematics College, Royal Melbourne Institute of Technology University, Melbourne, Australia
| | - Sacha Petersen
- School of Health and Biomedical Sciences, Science, Technology, Engineering, and Mathematics College, Royal Melbourne Institute of Technology University, Melbourne, Australia
| | - Ruby Walter
- School of Health and Biomedical Sciences, Science, Technology, Engineering, and Mathematics College, Royal Melbourne Institute of Technology University, Melbourne, Australia
| | - Lin Zhao
- School of Health and Biomedical Sciences, Science, Technology, Engineering, and Mathematics College, Royal Melbourne Institute of Technology University, Melbourne, Australia
| | - Kerryn Butler-Henderson
- School of Health and Biomedical Sciences, Science, Technology, Engineering, and Mathematics College, Royal Melbourne Institute of Technology University, Melbourne, Australia
| | - Karen Livesay
- School of Health and Biomedical Sciences, Science, Technology, Engineering, and Mathematics College, Royal Melbourne Institute of Technology University, Melbourne, Australia
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Vilendrer S, Saliba‐Gustafsson EA, Asch SM, Brown‐Johnson CG, Kling SM, Shaw JG, Winget M, Larson DB. Evaluating clinician‐led quality improvement initiatives: A system‐wide embedded research partnership at Stanford Medicine. Learn Health Syst 2022; 6:e10335. [PMID: 36263267 PMCID: PMC9576232 DOI: 10.1002/lrh2.10335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/25/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Many healthcare delivery systems have developed clinician‐led quality improvement (QI) initiatives but fewer have also developed in‐house evaluation units. Engagement between the two entities creates unique opportunities. Stanford Medicine funded a collaboration between their Improvement Capability Development Program (ICDP), which coordinates and incentivizes clinician‐led QI efforts, and the Evaluation Sciences Unit (ESU), a multidisciplinary group of embedded researchers with expertise in implementation and evaluation sciences. Aim To describe the ICDP‐ESU partnership and report key learnings from the first 2 y of operation September 2019 to August 2021. Methods Department‐level physician and operational QI leaders were offered an ESU consultation to workshop design, methods, and overall scope of their annual QI projects. A steering committee of high‐level stakeholders from operational, clinical, and research perspectives subsequently selected three projects for in‐depth partnered evaluation with the ESU based on evaluability, importance to the health system, and broader relevance. Selected project teams met regularly with the ESU to develop mixed methods evaluations informed by relevant implementation science frameworks, while aligning the evaluation approach with the clinical teams' QI goals. Results Sixty and 62 ICDP projects were initiated during the 2 cycles, respectively, across 18 departments, of which ESU consulted with 15 (83%). Within each annual cycle, evaluators made actionable, summative findings rapidly available to partners to inform ongoing improvement. Other reported benefits of the partnership included rapid adaptation to COVID‐19 needs, expanded clinician evaluation skills, external knowledge dissemination through scholarship, and health system‐wide knowledge exchange. Ongoing considerations for improving the collaboration included the need for multi‐year support to enable nimble response to dynamic health system needs and timely data access. Conclusion Presence of embedded evaluation partners in the enterprise‐wide QI program supported identification of analogous endeavors (eg, telemedicine adoption) and cross‐cutting lessons across QI efforts, clinician capacity building, and knowledge dissemination through scholarship.
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Affiliation(s)
- Stacie Vilendrer
- Department of Medicine, Division of Primary Care and Population Health Stanford University School of Medicine California USA
| | - Erika A. Saliba‐Gustafsson
- Department of Medicine, Division of Primary Care and Population Health Stanford University School of Medicine California USA
| | - Steven M. Asch
- Department of Medicine, Division of Primary Care and Population Health Stanford University School of Medicine California USA
| | - Cati G. Brown‐Johnson
- Department of Medicine, Division of Primary Care and Population Health Stanford University School of Medicine California USA
| | - Samantha M.R. Kling
- Department of Medicine, Division of Primary Care and Population Health Stanford University School of Medicine California USA
| | - Jonathan G. Shaw
- Department of Medicine, Division of Primary Care and Population Health Stanford University School of Medicine California USA
| | - Marcy Winget
- Department of Medicine, Division of Primary Care and Population Health Stanford University School of Medicine California USA
| | - David B. Larson
- Department of Radiology Stanford University School of Medicine California USA
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Vilendrer S, Lough ME, Garvert DW, Lambert MH, Lu JH, Patel B, Shah NH, Williams MY, Kling SMR. Nursing Workflow Change in a COVID-19 Inpatient Unit Following the Deployment of Inpatient Telehealth: Observational Study Using a Real-Time Locating System. J Med Internet Res 2022; 24:e36882. [PMID: 35635840 PMCID: PMC9208574 DOI: 10.2196/36882] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/13/2022] [Accepted: 05/11/2022] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic prompted widespread implementation of telehealth, including in the inpatient setting, with the goals to reduce potential pathogen exposure events and personal protective equipment (PPE) utilization. Nursing workflow adaptations in these novel environments are of particular interest given the association between nursing time at the bedside and patient safety. Understanding the frequency and duration of nurse-patient encounters following the introduction of a novel telehealth platform in the context of COVID-19 may therefore provide insight into downstream impacts on patient safety, pathogen exposure, and PPE utilization. OBJECTIVE The aim of this study was to evaluate changes in nursing workflow relative to prepandemic levels using a real-time locating system (RTLS) following the deployment of inpatient telehealth on a COVID-19 unit. METHODS In March 2020, telehealth was installed in patient rooms in a COVID-19 unit and on movable carts in 3 comparison units. The existing RTLS captured nurse movement during 1 pre- and 5 postpandemic stages (January-December 2020). Change in direct nurse-patient encounters, time spent in patient rooms per encounter, and total time spent with patients per shift relative to baseline were calculated. Generalized linear models assessed difference-in-differences in outcomes between COVID-19 and comparison units. Telehealth adoption was captured and reported at the unit level. RESULTS Change in frequency of encounters and time spent per encounter from baseline differed between the COVID-19 and comparison units at all stages of the pandemic (all P<.001). Frequency of encounters decreased (difference-in-differences range -6.6 to -14.1 encounters) and duration of encounters increased (difference-in-differences range 1.8 to 6.2 minutes) from baseline to a greater extent in the COVID-19 units relative to the comparison units. At most stages of the pandemic, the change in total time nurses spent in patient rooms per patient per shift from baseline did not differ between the COVID-19 and comparison units (all P>.17). The primary COVID-19 unit quickly adopted telehealth technology during the observation period, initiating 15,088 encounters that averaged 6.6 minutes (SD 13.6) each. CONCLUSIONS RTLS movement data suggest that total nursing time at the bedside remained unchanged following the deployment of inpatient telehealth in a COVID-19 unit. Compared to other units with shared mobile telehealth units, the frequency of nurse-patient in-person encounters decreased and the duration lengthened on a COVID-19 unit with in-room telehealth availability, indicating "batched" redistribution of work to maintain total time at bedside relative to prepandemic periods. The simultaneous adoption of telehealth suggests that virtual care was a complement to, rather than a replacement for, in-person care. However, study limitations preclude our ability to draw a causal link between nursing workflow change and telehealth adoption. Thus, further evaluation is needed to determine potential downstream implications on disease transmission, PPE utilization, and patient safety.
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Affiliation(s)
- Stacie Vilendrer
- Evaluation Sciences Unit, Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Mary E Lough
- Evaluation Sciences Unit, Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States.,Office of Research Patient Care Services, Stanford Health Care, Palo Alto, CA, United States
| | - Donn W Garvert
- Evaluation Sciences Unit, Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Monique H Lambert
- Office of Research Patient Care Services, Stanford Health Care, Palo Alto, CA, United States
| | - Jonathan Hsijing Lu
- Center for Biomedical Informatics Research, Stanford University School of Medicine, Stanford, CA, United States
| | - Birju Patel
- Center for Biomedical Informatics Research, Stanford University School of Medicine, Stanford, CA, United States
| | - Nigam H Shah
- Center for Biomedical Informatics Research, Stanford University School of Medicine, Stanford, CA, United States
| | - Michelle Y Williams
- Evaluation Sciences Unit, Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States.,Office of Research Patient Care Services, Stanford Health Care, Palo Alto, 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
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Acceptance of Psycho-Oncological Counseling Formats in a Cancer Counseling Center during the COVID-19 Pandemic: An Exploratory Care Study. ACTA ACUST UNITED AC 2021; 28:3795-3803. [PMID: 34677241 PMCID: PMC8535020 DOI: 10.3390/curroncol28050323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/20/2021] [Accepted: 09/25/2021] [Indexed: 12/03/2022]
Abstract
Background: The COVID-19 pandemic made it necessary to change established structures of medical counseling services and quickly establish digital counseling formats to ensure continuity of care. In this context, we offered telephone and video-telephonic counseling in addition to traditional face-to-face counseling in the office. Methods: Patients (n = 100) of the Cancer Counseling Center, Tübingen, were asked to complete a questionnaire to assess the acceptance of the counseling format following each counseling session (office, telephone, and video) in the period between July 2020 and February 2021. The questionnaire included the subject areas of patient characterization, assessment of therapeutic contact, therapeutic relationship, and hurdles and was used in this exploratory care study. Results: The satisfaction and acceptance of the three counseling formats (office, telephone, and video) were rated as “good” to “very good” in the three subgroups (range 1–6, office M = 1.2, telephone M = 1.3, video M = 1.4). Likewise, the “therapeutic relationship” achieved high ratings in terms of establishment of a therapeutic relationship in all three subgroups (office M = 5.7, telephone M = 5.0, video M = 5.0). The type of contact (office and video counseling) achieved a significant main effect on the therapeutic relationship for items such as “I believe that counseling is helping me” (F(2,97) = 4.80, p = 0.01) and “I feel that I can rely on the counselor/therapist” (F(2,97) = 3.29, p = 0.04). The “hurdles” were rated as minor and tolerable (office M = 1.3, telephone M = 1.3, video M = 1.4). Predictor analyses showed that there was no effect of age and gender on the acceptance of digital counseling formats in the present sample. Discussion and Conclusion: On the basis of this survey, it can be concluded that digital counseling formats were perceived by patients as a promising addition to the classic face-to-face setting. In addition, it can be stated that the digital formats (telephone and video) were not generally preferred to face-to-face counseling, but that the innovative telecounseling was accepted and perceived with great satisfaction and acceptance. Accordingly, the additional use of digital counseling formats could be an opportunity to enrich and expand the existing presence structures also after the COVID-19 pandemic.
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Vilendrer S, Sackeyfio S, Akinbami E, Ghosh R, Luu JH, Pathak D, Shimada M, Williamson EE, Shieh L. Patient Perspectives of Inpatient Telemedicine During COVID-19: A Qualitative Assessment (Preprint). JMIR Form Res 2021; 6:e32933. [PMID: 35147510 PMCID: PMC8970158 DOI: 10.2196/32933] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 01/26/2022] [Accepted: 01/27/2022] [Indexed: 01/23/2023] Open
Abstract
Background Telemedicine has been adopted in the inpatient setting to facilitate clinical interactions between on-site clinicians and isolated hospitalized patients. Such remote interactions have the potential to reduce pathogen exposure and use of personal protective equipment but may also pose new safety concerns given prior evidence that isolated patients can receive suboptimal care. Formal evaluations of the use and practical acceptance of inpatient telemedicine among hospitalized patients are lacking. Objective We aimed to evaluate the experience of patients hospitalized for COVID-19 with inpatient telemedicine introduced as an infection control measure during the pandemic. Methods We conducted a qualitative evaluation in a COVID-19 designated non–intensive care hospital unit at a large academic health center (Stanford Health Care) from October 2020 through January 2021. Semistructured qualitative interviews focused on patient experience, impact on quality of care, communication, and mental health. Purposive sampling was used to recruit participants representing diversity across varying demographics until thematic saturation was reached. Interview transcripts were qualitatively analyzed using an inductive-deductive approach. Results Interviews with 20 hospitalized patients suggested that nonemergency clinical care and bridging to in-person care comprised the majority of inpatient telemedicine use. Nurses were reported to enter the room and call on the tablet far more frequently than physicians, who typically entered the room at least daily. Patients reported broad acceptance of the technology, citing improved convenience and reduced anxiety, but preferred in-person care where possible. Quality of care was believed to be similar to in-person care with the exception of a few patients who wanted more frequent in-person examinations. Ongoing challenges included low audio volume, shifting tablet location, and inconsistent verbal introductions from the clinical team. Conclusions Patient experiences with inpatient telemedicine were largely favorable. Although most patients expressed a preference for in-person care, telemedicine was acceptable given the circumstances associated with the COVID-19 pandemic. Improvements in technical and care team use may enhance acceptability. Further evaluation is needed to understand the impact of inpatient telemedicine and the optimal balance between in-person and virtual care in the hospital setting.
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Affiliation(s)
- Stacie Vilendrer
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, United States
| | - Sarah Sackeyfio
- Department of Physics, Stanford University, Stanford, CA, United States
| | - Eliel Akinbami
- Department of Bioengineering, Stanford University, Stanford, CA, United States
| | - Roy Ghosh
- Department of Bioengineering, Stanford University, Stanford, CA, United States
| | - Jacklyn Ha Luu
- Department of Bioinformatics, Stanford University School of Medicine, Stanford, CA, United States
| | - Divya Pathak
- Department of Biochemistry, Stanford University, Stanford, CA, United States
| | - Masahiro Shimada
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, United States
| | | | - Lisa Shieh
- Division of Hospital Medicine, Stanford University School of Medicine, Stanford, CA, United States
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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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