BackgroundFormative evaluation is conducted in the early stages of system implementation to assess how it works in practice and to identify opportunities for improving technical and process performance. A formative evaluation of a teleneurophysiology service was conducted to examine its technical and sociological dimensions.MethodsA teleneurophysiology service providing routine EEG investigation was established. Service use, technical performance and satisfaction of clinical neurophysiology personnel were assessed qualitatively and quantitatively. These were contrasted with a previously reported analysis of the need for teleneurophysiology, and examination of expectation and satisfaction with clinical neurophysiology services in Ireland. A preliminary cost-benefit analysis was also conducted.ResultsOver the course of 40 clinical sessions during 20 weeks, 142 EEG investigations were recorded and stored on a file server at a satellite centre which was 130 miles away from the host clinical neurophysiology department. Using a virtual private network, the EEGs were accessed by a consultant neurophysiologist at the host centre for interpretation. The model resulted in a 5-fold increase in access to EEG services as well as reducing average waiting times for investigation by a half. Technically the model worked well, although a temporary loss of virtual private network connectivity highlighted the need for clarity in terms of responsibility for troubleshooting and repair of equipment problems. Referral quality, communication between host and satellite centres, quality of EEG recordings, and ease of EEG review and reporting indicated that appropriate organisational processes were adopted by the service. Compared to traditional CN service delivery, the teleneurophysiology model resulted in a comparable unit cost per EEG.ConclusionObservations suggest that when traditional organisational boundaries are crossed challenges associated with the social dimension of service delivery may be amplified. Teleneurophysiology requires a governance and management that recognises its socio-technical nature.
To determine current practices in the provision of video-EEG services, the authors conducted an international survey by post. The aim of the survey was to evaluate, by reference to other centres, how and why certain things are done, be assured that their own center is providing a quality service, identify weaknesses in their service, and from this, set improvement goals and objectives. A purposive sampling method was used by sending questionnaires to 78 hospitals where it was believed a long-term video-EEG monitoring service existed. Completed survey questionnaires were returned from 42 centers. Although the survey mechanism may have resulted in self-selection bias, evaluation of the responses provides information on patient management, staffing levels, equipment, and equipment management. Ultimately, these data may aid in identifying a minimum set of requirements for the provision of a video-EEG telemetry service.
BackgroundFeedback from service users will provide insight into opportunities for improvement so that performance can be optimised. In the context of a formative evaluation referring clinician and patient satisfaction with a teleneurophysiology service was examined during a 20 week pilot period.MethodsQuestionnaire surveys of referring clinicians and patients were conducted.ResultsFifteen (58%) clinicians responded to the first part of a postal survey which examined their satisfaction with traditional clinical neurophysiology services. Nine (35%) responded to a second part which assessed their experience with the teleneurophysiology service. Teleneurophysiology improved satisfaction with waiting times, availability of results and impact on patient management. There was unanimous support from the clinicians for the permanent development of a teleneurophysiology service, although 2 cautioned this could delay establishing a neurology service in their region.Eighty-two percent (116/142) of patients responded to a survey of their satisfaction with teleneurophysiology. This was compared to a previous report of 322 patients' experience with traditional CN services in Ireland. Waiting times for appointment were shorter for the former group who supported the telemedicine model recognising that it reduced the travel burden and need for overnight journeys. The two groups were equally anxious about the investigation although the teleneurophysiology patients received more prior information.ConclusionThis study illustrates that teleneurophysiology is an acceptable model of service delivery for its primary customers. Their feedback is important in informing appropriate design and governance of such innovative models of health service provision.
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