Patient Perspectives of Inpatient Telemedicine During the COVID-19 Pandemic: Qualitative Assessment (Preprint)

Abstract

BACKGROUND Telemedicine has been adopted in the inpatient setting to facilitate clinical interactions between on-site clinicians and isolated hospitalized patients for the purpose of infection control during the COVID-19 pandemic. 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 into the use and practical acceptance of inpatient telemedicine amongst 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 To understand the patient perspective on inpatient telemedicine use, we performed a qualitative evaluation in a COVID-19 designated non-intensive care hospital unit at a large academic health center (Stanford Health Care). Semi-structured qualitative interviews were conducted October 2020 through January 2021 primarily by phone and focused on patient experience, impact on quality of care, communication, and mental health. Purposive sampling were used to recruit participants representing diversity across varying demographics until thematic saturation was reached. Interview transcripts were qualitatively analyzed using an inductive-deductive approach and presented using an implementation outcomes framework. RESULTS Interviews with 20 hospitalized patients suggested non-emergency clinical encounters 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 accepted the technology, citing reduced fear and anxiety, given their isolation status but preferred in-person care if given the choice. Suboptimal factors were noted including low volume, shifting tablet location, and inconsistent verbal introductions from the clinical team. 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. CONCLUSIONS Patient experiences with inpatient telemedicine were largely favorable. Although most patients expressed a preference for in-person care when possible, telemedicine was acceptable given the circumstances. Technical and protocol improvements 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.