Telemedicine for Interfacility Nurse Handoffs*

Abstract

Objective: To compare nurse preparedness and quality of patient handoff during interfacility transfers from a pretransfer emergency department to a PICU when conducted over telemedicine versus telephone. Design: Cross-sectional nurse survey linked with patient electronic medical record data using multivariable, multilevel analysis. Setting: Tertiary PICU within an academic children’s hospital. Participants: PICU nurses who received a patient handoff between October 2017 and July 2018. Interventions: None. Main Results and Measurements: Among 239 eligible transfers, 106 surveys were completed by 55 nurses (44% survey response rate). Telemedicine was used for 30 handoffs (28%), and telephone was used for 76 handoffs (72%). Patients were comparable with respect to age, sex, race, primary spoken language, and insurance, but handoffs conducted over telemedicine involved patients with higher illness severity as measured by the Pediatric Risk of Mortality III score (4.4 vs 1.9; p = 0.05). After adjusting for Pediatric Risk of Mortality III score, survey recall time, and residual clustering by nurse, receiving nurses reported higher preparedness (measured on a five-point adjectival scale) following telemedicine handoffs compared with telephone handoffs (3.4 vs 3.1; p = 0.02). There were no statistically significant differences in both bivariable and multivariable analyses of handoff quality as measured by the Handoff Clinical Evaluation Exercise. Handoffs using telemedicine were associated with increased number of Illness severity, Patient summary, Action list, Situation awareness and contingency planning, Synthesis by receiver components (3.3 vs 2.8; p = 0.04), but this difference was not significant in the adjusted analysis (3.1 vs 2.9; p = 0.55). Conclusions: Telemedicine is feasible for nurse-to-nurse handoffs of critically ill patients between pretransfer and receiving facilities and may be associated with increased perceived and objective nurse preparedness upon patient arrival. Additional research is needed to demonstrate that telemedicine during nurse handoffs improves communication, decreases preventable adverse events, and impacts family and provider satisfaction.

Impact of Tele-Emergency Consultations on Pediatric Interfacility Transfers

“… 36 , 37 In addition, telemedicine can be used to include the referring bedside nurse, which could increase their confidence in caring for children in their own EDs. 38 …”

“…Using telemedicine with a remote pediatric specialist provides local physicians and families with more support, both clinically and emotionally, than a standard telephone conversation and could result in lower levels of parental distress . In addition, telemedicine can be used to include the referring bedside nurse, which could increase their confidence in caring for children in their own EDs …”

Desenvolvimento de aplicativo móvel para passagem de plantão na emergência utilizando National Early Warning Score

“…Puderam-se observar, durante o desenvolvimento e validação do PPSE, que estudos demonstram que o emprego de um sistema padronizado de informações e de um sistema eletrônico para transferência de cuidados melhora a comunicação de informações cruciais para a continuidade do cuidado (20,21) . O propósito do PPSE fica evidenciado e tem esse objetivo, tendo os especialistas deixado clara a importância da sua utilização na prática de enfermagem: Esp 1: "App bem completo, contempla as principais informações da passagem de plantão na sala de emergência"; Esp 2: "o App adapta-se bem à realidade de cada região do país".…”

Nurse-to-family telehealth for pediatric transfers: protocol for a feasibility and pilot cluster randomized controlled trial

“…Most pediatric inter-facility telehealth research has examined the use of telehealth by physicians [14][15][16][17]. The research examining telehealth use by nurses has studied nurse-to-nurse telehealth handoffs during the transfer process [21]. However, the feasibility and impact of nurse-to-family telehealth visits during pediatric transfers remains a research gap.…”