A systematic review of telehealth applications in hospital medicine

Abstract

Background: Despite the proliferation of telehealth, uptake for acute inpatient services has been slower. Hospitalist shortages in rural and critical access hospitals as well as the COVID-19 pandemic have led to a renewed interest in telehealth to deliver acute inpatient services. Understanding current evidence is crucial for promoting uptake and developing evidence-based practices.Objective: To conduct a systematic review of telehealth applications in acute inpatient general medicine and pediatric hospital wards and synthesize available evidence. Data Sources: A search of five databases (PubMed, CINAHL, Embase, Scopus, and ProQuest Theses, and Dissertations) using a combination of search terms including telemedicine and hospital medicine/inpatient care keywords yielded 17,015 citations. Study Selection and Data Extraction: Two independent coders determined eligibility based on inclusion and exclusion criteria. Data were extracted and organized into main categories based on findings: (1) feasibility and planning, (2) implementation and technology, and (3) telehealth application process and outcome measures. Results: Of the 20 publications included, three were feasibility and planning studies describing the creation of the program, services provided, and potential cost implications. Five studies described implementation and technology used, including training, education, and evaluation methods. Finally, twelve discussed process and outcome measures, including patient and provider satisfaction and costs. Conclusion:Telehealth services for hospital medicine were found to be effective, well received, and initial cost estimates appear favorable. A variety of services were described across programs with considerable benefit appreciated by rural and smaller hospitals.Additional work is needed to evaluate clinical outcomes and overall program costs.

Characteristics and perceptions of utilising telehealth for predominantly middle‐aged to older, metropolitan‐based general medical patients

“…The settings were in all clinical services in general medicine, where data on TH use and patient perceptions are limited. 17,19 Finally, no previous study surveyed patients independent of their TH appointments to the best of our knowledge. Despite the evidence of high patient acceptance, the benefits of TH and pandemic-forced digital transformation, [8][9][10][11]17 most patients in this study (80.8%) preferred face-to-face appointments.…”

“…15,16 Data on TH use in general medicine that represents broader clinical services and perceptions irrespective of TH appointments are limited. 18,19 This study aimed to investigate the characteristics and perceptions in utilising TH of adult patients receiving general medical care as inpatients, outpatients and in the community in a statewide tertiary hospital in Victoria, Australia, independent of their TH appointments.…”

“…However, many studies were limited by potential selection bias by only examining patients who had undergone TH consults, small sample size, primary care or discipline‐specific 8–11,13,14,17,18 and indirect measures of patient characteristics 15,16 . Data on TH use in general medicine that represents broader clinical services and perceptions irrespective of TH appointments are limited 18,19 …”

Estimating and planning hospital costs of public hospitals in Brazil

“…The estimates allowed us to draw inferences about hospitals' annual costs. However, we did not evaluate how much a hospital should cost nor the impact of new technologies, such as telehealth [49], on hospitals' costs. Therefore, future research can explore the efficiency and effectiveness metrics, location, and hierarchy influence on hospitals' budgeting since hospital funding should not be considered in isolation from the health care system.…”

Telemedicine for the hospitalist: Expanding telemedicine beyond outpatient and subspecialty use

“…It forces the question, is a new way better? In this issue of JHM , the review by Gutierez et al 1 provides a systematic review of applications of telehealth services by hospitalists. It suggests that telehealth expands and improves the quality of care, especially in critical access and rural hospitals, without reducing patient satisfaction or increasing costs.…”