Literature on telehealth care delivery often addresses clinical, cost, technological, system, and organizational impacts. Less is known about interpersonal behaviors such as communication patterns ...and therapeutic relationship-building, which may have workforce development considerations. The purpose of this study was to conduct a systematic literature review to identify interpersonal health care provider (HCP) behaviors and attributes related to provider–patient interaction during care in telehealth delivery. Electronic searches were conducted using five indexes/databases: CINAHL, ERIC, PsychInfo, ProQuest Dissertations, PubMed; with hand-searching of the immediate past 10 years of five journals. Search concepts included: communication, telehealth, education, and health care delivery. Of 5261 unique article abstracts initially identified, 338 full-text articles remained after exclusion criteria were applied and these were reviewed for eligibility. Finally, data were extracted from 45 articles. Through qualitative synthesis of the 45 articles, we noted that papers encompassed many disciplines and targeted care to people in many settings including: home care, primary and specialist care, mental health/counseling, and multi-site teams. Interpersonal behaviors were observed though not manipulated through study designs. Six themes were identified: HCP-based support for telehealth delivery; provider–patient interactions during the telehealth event; environmental attributes; and guidelines for education interventions or evaluation of HCP behaviors. Although unable to identify current best practices, important considerations for practice and education did emerge. These include: perceptions of the utility of telehealth; differences in communication patterns such as pace and type of discourse, reliance on visual cues by both provider and patient especially in communicating empathy and building rapport; and confidentiality and privacy in telehealth care delivery.
•Mobile-device-based serious game applications may complement traditional simulation training.•The Uncertainty Communication app was favorably reviewed, but did not improve performance.•When ...implemented as a voluntary component of the educational intervention, most participants opted not to use this training opportunity.
Clear communication is integral to good clinical care; however, communication training is cost and time intensive. Mobile applications (apps) may provide a useful adjunct to traditional simulation skills training.
To evaluate (1) use of an app for teaching communication skills about diagnostic uncertainty, (2) feedback on app use, and (3) the association between use and skill mastery.
The app under study is designed to improve doctor-patient communication.
The study was a planned sub-analysis of a randomized controlled waitlist trial with emergency medicine resident physicians randomized to receive immediate or delayed access to an educational curriculum focused on diagnostic uncertainty. The curriculum included a web-based interactive module and the app. Metrics describing participants’ use of the app, feedback on use, and association of use and achieving mastery in communicating diagnostic uncertainty are reported. Differences between groups utilizing the app were analyzed using Chi-squared test; logistic regression assessed the association between app use and achieving mastery of the communication skill.
Among 109 participants completing the trial, only 34 (31.2%) used the app. Most participants engaged with the app on one occasion for a median of 50 min (IQR 31, 87). Senior residents were more likely to use the app than junior residents (41.3% vs 23.8%, p=0.05). Overall reviews were positive; 76% reported the app helped them learn. There was no significant association between app use and achieving mastery of the communication skill in the trial OR 2.1, 95% CI (0.91–4.84).
Despite positive reviews of app use, overall use was low and there was no association with achieving mastery.
Offering an app as an auxiliary training opportunity may be beneficial to some residents, but shouldn’t be planned for use as a primary didactic modality unless there is evidence for effectiveness and use is mandated.
The datasets generated and/or analyzed during the current study are not publicly available since some data may be identifiable but are available from the corresponding author on reasonable request.
The aims of the study were to evaluate whether in situ (on-site) simulation training is associated with increased telemedicine use for patients presenting to rural emergency departments (EDs) with ...severe sepsis and septic shock and to evaluate the association between simulation training and telehealth with acute sepsis bundle (SEP-1) compliance and mortality.
This was a quasi-experimental study of patients presenting to 2 rural EDs with severe sepsis and/or septic shock before and after rollout of in situ simulation training that included education on sepsis management and the use of telehealth. Unadjusted and adjusted analyses were conducted to describe the association of simulation training with sepsis process of care markers and with mortality.
The study included 1753 patients, from 2 rural EDs, 629 presented before training and 1124 presented after training. There were no differences in patient characteristics between the 2 groups. Compliance with several SEP-1 bundle components improved after training: antibiotics within 3 hours, intravenous fluid administration, repeat lactic acid assessment, and vasopressor administration. The use of telemedicine increased from 2% to 5% after training. Use of telemedicine was associated with increases in repeat lactic acid assessment and reassessment for septic shock. We did not demonstrate an improvement in mortality across either of the 2 group comparisons.
We demonstrate an association between simulation and improved care delivery. Implementing an in situ simulation curriculum in rural EDs was associated with a small increase in the use of telemedicine and improvements in sepsis process of care markers but did not demonstrate improvement in mortality. The small increase in telemedicine limited conclusions on its impact.
Background
Research into efforts to engage patients in the assessment of health‐care teams is limited.
Objective
To explore, through qualitative methods, patient awareness of teamwork‐related ...behaviours observed during an emergency department (ED) visit.
Design
Researchers used semi‐structured question guides for audio‐recorded interviews and analysed their verbatim transcripts.
Setting and participants
Researchers conducted individual phone interviews with 6 teamwork subject matter experts (SMEs) and held 5 face‐to‐face group interviews with patients and caregivers (n = 25) about 2 weeks after discharge from the emergency department (ED).
Results
SMEs suggested that a range of factors influence patient perspectives of teams. Many patients perceived the health‐care team within the context of their expectations of an ED visit and their treatment plan. Four themes emerged: (i) patient‐centred views highlight gaps in coordination and communication; (ii) team processes do concern patients; (iii) patients are critical observers of ways that team members present their team roles; (iv) patients’ observations of team members relate to patients’ views of team effectiveness. Analysis also indicated that patients viewed health‐care team members’ interactions with each other as proxy for how team members actually felt about patients.
Discussion
Results from both sets of interviews (SME and patient) indicated that patient observations of teamwork could add to assessment of team processes/frameworks. Patients’ understanding about teamwork organization seemed helpful and witnessed interteam communication appeared to influence patient confidence in the team.
Conclusion
Patients perspectives are an important part of assessment in health care and suggest potential areas for improvement through team training.
The coronavirus disease 2019 pandemic disrupted health care, requiring organizational leaders to act quickly to manage the health-related concerns of individuals and communities. The ability to offer ...a variety of digitally enabled telehealth services with 24/7 access to nurse practitioners and physician assistants allowed us to care for patients in their homes. It reduced the spread of the virus, protected our employees from further disease spread, and provided early interventions to those in need. The roles of nurse practitioner leaders, the enacted strategies, and patient outcomes demonstrate the impact of an innovative digital care delivery model on care across the continuum.
•Human-centered care and patient engagement can be achieved with digital platforms.•Nurse practitioners and physician assistants can effectively deliver telehealth.•Innovative digital solutions improve care with the appropriate use of clinical expertise.
Improving Handoffs in the Emergency Department Cheung, Dickson S., MD, MBA, MPH; Kelly, John J., DO; Beach, Christopher, MD ...
Annals of emergency medicine,
02/2010, Volume:
55, Issue:
2
Journal Article
Peer reviewed
Patient handoffs at shift change are a ubiquitous and potentially hazardous process in emergency care. As crowding and lengthy evaluations become the standard for an increasing proportion of ...emergency departments (EDs), the number of patients handed off will likely increase. It is critical now more than ever before to ensure that handoffs supply valid and useful shared understandings between providers at transitions of care. The purpose of this article is to provide the most up-to-date evidence and collective thinking about the process and safety of handoffs between physicians in the ED. It offers perspectives from other disciplines, provides a conceptual framework for handoffs, and categorizes models of existing practices. Legal and risk management issues are also addressed. A proposal for the development of handoff quality measures is outlined. Practical strategies are suggested to improve ED handoffs. Finally, a research agenda is proposed to provide a roadmap to future work that may increase knowledge in this area.
O'Connor, LM and Vozenilek, JA. Is it the athlete or the equipment? An analysis of the top swim performances from 1990 to 2010. J Strength Cond Res 25(12): 3239-3241, 2011-Forty-three world record ...swims were recorded at the 2009 Fédération Internationale de Natation (FINA) World Championship meet in Rome. Of the 20 FINA recognized long-course (50-m pool) swimming events, men set new world records in 15 of those events, whereas women did the same in 17 events. Each of the men's world records and 14 of the 17 women's records still stand. These performances were unprecedented; never before had these many world records been broken in such a short period of time. There was much speculation that full-body, polyurethane, technical swimsuits were the reason for the conspicuous improvement in world records. Further analysis led the FINA to institute new rules on January 1, 2010, that limited the types of technical swimsuits that could be worn by athletes. No long-course world record has been broken since then. We sought to understand this phenomenon by analyzing publicly available race data and exploring other possible causes including improvements in other sports, improvements in training science, changes in rules and regulations, gender differences, anaerobic vs. aerobic events, unique talent, and membership data.
Highlights • We explored observations of teamwork-related behaviors among ED patients/caregivers. • The PIVOT survey offers a means to collect patient/caregivers views of teamwork. • Participant ...responses revealed awareness of team communication and coordination. • Those with longer ED stays were more likely to report problematic team behaviors. • Engaging patients in evaluation of health care teams can reveal actionable fixes.
The Accreditation for Graduate Medical Education has developed a new process of accreditation, the Next Accreditation System (NAS), which focuses on outcomes. A key component of the NAS is specialty ...milestones-specific behavior, attributes, or outcomes within the general competency domains. Milestones will mark a level of proficiency of a resident within a competency domain. Each specialty has developed its own set of milestones, with semiannual reporting to begin July 2013, for 7 specialties, and the rest in July 2014.Milestone assessment must be based on objective data. Each specialty will determine optimal methods of measuring milestones, based on ease, cost, validity, and reliability. The simulation community has focused many graduate medical education efforts at training and formative assessment. Milestone assessment represents an opportunity for simulation modalities to offer summative assessment of milestone proficiencies, adding to the potential methods that residency programs will likely use or adapt. This article discusses the NAS, milestone assessment, and the opportunity to the simulation community to become involved in this next stage of graduate medical education assessment.
New technologies for clinical staff are typically introduced via an "in-service" that focuses on knowledge and technical skill. Successful adoption of new healthcare technologies is influenced by ...multiple other factors as described by the Consolidated Framework in Implementation Research (CFIR). A simulation-based introduction to new technologies provides opportunity to intentionally address specific factors that influence adoption.
The new technology proposed for adoption was a telehealth cart that provided direct video communication with electronic intensive care unit (eICU) staff for a rural Emergency Department (ED). A novel 3-Act-3-Debrief in situ simulation structure was created to target predictive constructs from the CFIR and connect debriefing to specific workflows. The structure and content of the simulation in relation to the framework is described. Participants completed surveys pre-simulation/post-simulation to measure change in their readiness to adopt the new technology.
The scenario was designed and pilot tested before implementation at two rural EDs. There were 60 interprofessional participants across the 2 sites, with 58 pre-simulation and 59 post-simulation surveys completed. The post-simulation mean ratings for each readiness measure (feasibility, quality, resource availability, role clarity, staff receptiveness, and tech usability) increased significantly as a result of the simulation experience.
A novel 3-stage simulation-debriefing structure positively targets factors influencing the adoption of new healthcare technologies.
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