The Impact of Inpatient Telemedicine on Personal Protective Equipment Savings During the COVID-19 Pandemic: Cross-sectional Study

Halabi, Reem; Smith, Geoffrey; Sylwestrzak, Marc; Clay, Brian; Longhurst, Chris; Lander, Lina

doi:10.2196/28845

Cited by 8 publications

(5 citation statements)

References 13 publications

(29 reference statements)

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“… [12] , [13] , [14] , [15] These studies demonstrated several advantages to these types of systems, including minimizing provider exposure [6] and managing surge capacity [16] as well as potential drawbacks such as device connectivity issues [12] , difficulty performing physical exams [17] , and variability in patient receptiveness to telemedicine. [12] While some recent evidence has cast doubt upon if inpatient telemedicine truly conserves PPE [18] , several studies have described innovative approaches to emergency care using telemedicine which have blossomed from improved telemedicine infrastructure including monitoring of high-risk discharged patients [19] , remote consults to the ED [20] , or training of new providers. [21] This study moves beyond simply describing the implementation process and begins to examine how telemedicine actually impacts clinical process metrics within the ED considering the changes in clinical workflow that telemedicine necessitates.…”

Section: Discussionmentioning

confidence: 99%

Impact of telemedicine on clinical practice patterns for patients with chest pain in the emergency department

Ostberg

Brown

et al. 2022

International Journal of Medical Informatics

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Section: Discussionmentioning

confidence: 99%

Impact of telemedicine on clinical practice patterns for patients with chest pain in the emergency department

Ostberg

Brown

et al. 2022

International Journal of Medical Informatics

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“…This novel use of inpatient telemedicine is still being explored: in one academic medical setting, the technology was broadly accepted by clinicians and staff but required nurses to drastically alter their workflow practices [ 27 ]. In another setting, in-room video technology saw the greatest adoption among patients who used it to communicate with their loved ones [ 28 ]. Little else is formally known about how patients perceive inpatient telemedicine, particularly under isolation conditions that a COVID-19 diagnosis necessitates.…”

Section: Introductionmentioning

confidence: 99%

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

Vilendrer¹,

Sackeyfio²,

Akinbami³

et al. 2022

JMIR Form Res

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Background Telemedicine has been adopted in the inpatient setting to facilitate clinical interactions between on-site clinicians and isolated hospitalized patients. 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 of the use and practical acceptance of inpatient telemedicine among 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 We conducted a qualitative evaluation in a COVID-19 designated non–intensive care hospital unit at a large academic health center (Stanford Health Care) from October 2020 through January 2021. Semistructured qualitative interviews focused on patient experience, impact on quality of care, communication, and mental health. Purposive sampling was used to recruit participants representing diversity across varying demographics until thematic saturation was reached. Interview transcripts were qualitatively analyzed using an inductive-deductive approach. Results Interviews with 20 hospitalized patients suggested that nonemergency clinical care and bridging to in-person care 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 reported broad acceptance of the technology, citing improved convenience and reduced anxiety, but preferred in-person care where possible. 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. Ongoing challenges included low audio volume, shifting tablet location, and inconsistent verbal introductions from the clinical team. Conclusions Patient experiences with inpatient telemedicine were largely favorable. Although most patients expressed a preference for in-person care, telemedicine was acceptable given the circumstances associated with the COVID-19 pandemic. Improvements in technical and care team use 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.

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“…In the inpatient setting, telehealth was previously used to connect hospitalized patients in rural settings with remote specialists [ 3 ], but has recently expanded to facilitate digital communication between patients and on-site clinicians [ 4 - 6 ]. The impact of inpatient telehealth on infection reduction [ 7 ], clinical workflows [ 8 , 9 ], patient safety [ 10 ], and personal protective equipment (PPE) utilization [ 10 , 11 ] is still under investigation. In the context of a pandemic, telehealth’s impact on infection control and clinical care is of particular interest, although existing evaluations have relied on PPE inventory data and patient and provider satisfaction surveys [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

“…The impact of inpatient telehealth on infection reduction [ 7 ], clinical workflows [ 8 , 9 ], patient safety [ 10 ], and personal protective equipment (PPE) utilization [ 10 , 11 ] is still under investigation. In the context of a pandemic, telehealth’s impact on infection control and clinical care is of particular interest, although existing evaluations have relied on PPE inventory data and patient and provider satisfaction surveys [ 10 , 11 ]. However, the expanding use of real-time locator systems (RTLSs), as an objective source of location and time data, in inpatient settings offers a unique opportunity to understand how clinical workflows adapt to these novel circumstances.…”

Section: Introductionmentioning

confidence: 99%

Nursing Workflow Change in a COVID-19 Inpatient Unit Following the Deployment of Inpatient Telehealth: Observational Study Using a Real-Time Locating System

Vilendrer¹,

Lough²,

Garvert³

et al. 2022

J Med Internet Res

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Background The COVID-19 pandemic prompted widespread implementation of telehealth, including in the inpatient setting, with the goals to reduce potential pathogen exposure events and personal protective equipment (PPE) utilization. Nursing workflow adaptations in these novel environments are of particular interest given the association between nursing time at the bedside and patient safety. Understanding the frequency and duration of nurse-patient encounters following the introduction of a novel telehealth platform in the context of COVID-19 may therefore provide insight into downstream impacts on patient safety, pathogen exposure, and PPE utilization. Objective The aim of this study was to evaluate changes in nursing workflow relative to prepandemic levels using a real-time locating system (RTLS) following the deployment of inpatient telehealth on a COVID-19 unit. Methods In March 2020, telehealth was installed in patient rooms in a COVID-19 unit and on movable carts in 3 comparison units. The existing RTLS captured nurse movement during 1 pre- and 5 postpandemic stages (January-December 2020). Change in direct nurse-patient encounters, time spent in patient rooms per encounter, and total time spent with patients per shift relative to baseline were calculated. Generalized linear models assessed difference-in-differences in outcomes between COVID-19 and comparison units. Telehealth adoption was captured and reported at the unit level. Results Change in frequency of encounters and time spent per encounter from baseline differed between the COVID-19 and comparison units at all stages of the pandemic (all P<.001). Frequency of encounters decreased (difference-in-differences range –6.6 to –14.1 encounters) and duration of encounters increased (difference-in-differences range 1.8 to 6.2 minutes) from baseline to a greater extent in the COVID-19 units relative to the comparison units. At most stages of the pandemic, the change in total time nurses spent in patient rooms per patient per shift from baseline did not differ between the COVID-19 and comparison units (all P>.17). The primary COVID-19 unit quickly adopted telehealth technology during the observation period, initiating 15,088 encounters that averaged 6.6 minutes (SD 13.6) each. Conclusions RTLS movement data suggest that total nursing time at the bedside remained unchanged following the deployment of inpatient telehealth in a COVID-19 unit. Compared to other units with shared mobile telehealth units, the frequency of nurse-patient in-person encounters decreased and the duration lengthened on a COVID-19 unit with in-room telehealth availability, indicating “batched” redistribution of work to maintain total time at bedside relative to prepandemic periods. The simultaneous adoption of telehealth suggests that virtual care was a complement to, rather than a replacement for, in-person care. However, study limitations preclude our ability to draw a causal link between nursing workflow change and telehealth adoption. Thus, further evaluation is needed to determine potential downstream implications on disease transmission, PPE utilization, and patient safety.

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The Impact of Inpatient Telemedicine on Personal Protective Equipment Savings During the COVID-19 Pandemic: Cross-sectional Study

Cited by 8 publications

References 13 publications

Impact of telemedicine on clinical practice patterns for patients with chest pain in the emergency department

Impact of telemedicine on clinical practice patterns for patients with chest pain in the emergency department

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

Nursing Workflow Change in a COVID-19 Inpatient Unit Following the Deployment of Inpatient Telehealth: Observational Study Using a Real-Time Locating System

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