Clinician Attitudes Toward Adoption of Pediatric Emergency Telemedicine in Rural Hospitals

Ray, Kristin N.; Felmet, Kathryn; Hamilton, Melinda Fiedor; Kuza, Courtney C.; Saladino, Richard A.; Schultz, Bruce D.; Watson, R. Scott; Kahn, Jeremy M.

doi:10.1097/pec.0000000000000583

Cited by 55 publications

(48 citation statements)

References 23 publications

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“…Despite this body of literature, our study and prior studies suggest that uncertainty regarding telemedicine's benefits continues to impede its adoption . Ray et al . proposed developing guidelines for which specific clinical conditions are appropriate for telemedicine use.…”

Section: Discussionmentioning

confidence: 62%

“…We must address these biases to gain end‐user buy‐in. Although a prior mixed‐methods pediatric telemedicine study highlighted the need to gain buy‐in among community clinicians, another study emphasized the need to gain buy‐in from both referring and accepting physicians . Our study identified the greatest resistance among accepting physicians; we thus propose efforts to address buy‐in should target this group.…”

Section: Discussionmentioning

confidence: 73%

“…Many of the barriers to telemedicine acceptability identified in this study are consistent with previously reported findings. These barriers include technology challenges, poor workflow integration, and uncertainty of the benefits . To our knowledge, classifying certain barriers as negative biases toward telemedicine is unique to our study.…”

Section: Discussionmentioning

confidence: 97%

“…Despite its recognized value and availability, telemedicine is not universally employed during hospital‐to‐hospital transfers, suggesting that barriers exist that prevent its adoption and uptake . Prior studies have explored the acceptability of telemedicine; however, these studies have included mostly participants with little to no pediatric telemedicine experience, have explored telemedicine use for nonemergency settings, or have used survey data collection methods rather than in‐depth interviews . Identified barriers to telemedicine use from these prior studies include technology challenges, workflow integration, perceived usefulness, regulatory issues, and costs .…”

mentioning

confidence: 99%

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Acceptability, Usability, and Effectiveness: A Qualitative Study Evaluating a Pediatric Telemedicine Program

Sauers‐Ford

Hamline

Gosdin

et al. 2019

Academic Emergency Medicine

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Background: Pediatric emergency telemedicine consultations have been shown to provide support to community emergency departments treating critically ill pediatric patients. However, despite the recognized value of telemedicine, adoption has been slow. To determine why clinicians frequently do not use telemedicine when it is available for pediatric patients, as well as to learn how to improve telemedicine programs, we conducted a qualitative study using stakeholder interviews.Methods: We conducted a qualitative study using grounded theory methodology, with in-depth interviews of referring and accepting physicians and referring, transport, and transfer center nurses. We analyzed data iteratively and adapted the interview guide based on early interviews. We solicited feedback from the participants on the conceptual model.Results: Sixteen interviews were conducted; all respondents had been involved in a telemedicine consultation at least five times, with some having used telemedicine more than 30 times. Analysis resulted in three themes: 1) recognizing and addressing telemedicine biases are central to gaining buy-in; 2) as technology advances, telemedicine processes need to adapt accordingly; and 3) telemedicine increases collaboration among health care providers and patients/families in the patient care process.Conclusions: To improve patient care through increased use of telemedicine for pediatric emergency consultations, processes need to be modified to address provider biases and end-user concerns. Processes should be adapted to allow users to utilize a variety of technologies (including smartphones) and to enable more users, such as nurses, to participate. Finally, telemedicine can be used to improve the patient and family experience by including them in consultations.

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Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 97%

mentioning

confidence: 99%

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Acceptability, Usability, and Effectiveness: A Qualitative Study Evaluating a Pediatric Telemedicine Program

Sauers‐Ford

Hamline

Gosdin

et al. 2019

Academic Emergency Medicine

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“…Telemedicine offers another potential means of extending pediatric expertise to additional EDs. Prior studies report that telemedicine is of interest to parents experiencing transfers, may improve evaluation quality, and may reduce illness severity among children requiring transfer, although numerous barriers still face the uptake and sustainability of pediatric emergency telemedicine programs …”

Section: Discussionmentioning

confidence: 99%

Referring Hospital Characteristics Associated With Potentially Avoidable Emergency Department Transfers

Ray

Marin

et al. 2018

Academic Emergency Medicine

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Among pediatric emergency transfers in a large state Medicaid program with a nearly 20% probably avoidable transfer rate, there was significant hospital-level variation in the proportion of probably avoidable transfers. Transfers from hospitals in large metropolitan areas and transfers from hospitals without pediatric-specific capabilities had increased odds of being probably avoidable transfers, such that these hospitals may represent targets for interventions to reduce these transfers.

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Telehealth use in emergency care during coronavirus disease 2019: a systematic review

et al. 2021

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Objective: The coronavirus disease 2019 pandemic has presented emergency departments (EDs) with many challenges to address the acute care needs of patients. Many EDs have leveraged telehealth to innovatively respond to these challenges. This review describes the landscape of telehealth initiatives in emergency care that have been described during the coronavirus disease 2019 pandemic. Methods:We conducted a comprehensive, systematic review of the literature using PubMed, supplemented by a review of the gray literature (ie, non-peer reviewed), with input from subject matter experts to identify telehealth initiatives in emergency care during coronavirus disease 2019. We categorized types of telehealth use based on purpose and user characteristics. Results:We included 27 papers from our review of the medical literature and another 8 sources from gray literature review. The vast majority of studies (32/35) were descriptive in nature, with the additional inclusion of 2 cohort studies and one randomized clinical trial. There were 5 categories of ED telehealth use during the pandemic: (1) pre-ED evaluation and screening, (2) within ED (including as a means of limiting staff and patient exposure and facilitating consultation with specialists), (3) post-ED discharge monitoring and treatment, (4) educating trainees and health care workers, and (5) coordinating resources and patient care. Conclusion:Telehealth has been used in a variety of manners during the coronavirus disease 2019 pandemic, enabling innovation in emergency care delivery. The findings from this study can be used by institutions to consider how telehealth may address challenges in emergency care during the coronavirus disease 2019 pandemic and beyond. Because few studies included cost data and given the variability in institutional resources, how organizations implement telehealth programs will likely vary. Future work should further explore barriers and facilitators of innovation, and the impact on care delivery and patient outcomes.

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Clinician Attitudes Toward Adoption of Pediatric Emergency Telemedicine in Rural Hospitals

Cited by 55 publications

References 23 publications

Acceptability, Usability, and Effectiveness: A Qualitative Study Evaluating a Pediatric Telemedicine Program

Acceptability, Usability, and Effectiveness: A Qualitative Study Evaluating a Pediatric Telemedicine Program

Referring Hospital Characteristics Associated With Potentially Avoidable Emergency Department Transfers

Telehealth use in emergency care during coronavirus disease 2019: a systematic review

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