An Integrated Nursing and Telemedicine Approach to Vascular Care

Bangs, Iris; Clarke, Malcolm; Hands, Linda; Jones, Russell; Knott, Mary; Mahaffey, Wendy

doi:10.1177/1357633x020080s250

Cited by 5 publications

(6 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Few reports have discussed the use of teledermatology in the diagnosis and care of patients with leg ulcers. [2][3][4][5][6][7] The diagnosis of leg ulcers is usually straightforward, whether it is made by clinical examination or based on a digital image. Treatment suggestions are usually based on the clinical presentation of the ulcer and the surrounding skin, the classification of the ulcer, information on previous therapeutic modalities and therapeutic response, known allergic reactions of the patient, and on the clinician's personal experience with different dressings and preferences.…”

Section: Discussionmentioning

confidence: 99%

Feasibility and acceptance of telemedicine for wound care in patients with chronic leg ulcers

et al. 2006

View full text Add to dashboard Cite

We examined the feasibility and acceptance of teledermatology for wound management of patients with chronic leg ulcers by home-care nurses. Forty-one chronic leg ulcers of different origin in 14 patients were included. After an initial in-person visit in which leg ulcers were assessed and classified, and underlying diseases noted, follow-up visits were done by home-care nurses. Once a week 1-4 digital images of the wound and surrounding skin and relevant clinical information were transmitted via a secure Website to an expert at the wound care centre. The experts provided an assessment of wound status and therapeutic recommendations. In 89% of the 492 teleconsultations, the quality of images was sufficient or excellent and the experts were confident giving therapeutic recommendations. Treatment modalities were changed or adapted in one-third of the consultations. There was a significant decrease in visits to a general physician or the wound care centre. The acceptance of teledermatology was high in patients, home-care nurses and wound experts. Teledermatology offers great potential for chronic wound care and seems to be accepted both by patients and health-care persons.

show abstract

Section: Discussionmentioning

confidence: 99%

Feasibility and acceptance of telemedicine for wound care in patients with chronic leg ulcers

et al. 2006

View full text Add to dashboard Cite

show abstract

“…In vascular surgery, initial reports on the utility of these technologies appeared in the literature 20 years ago. 32,33,37 Despite data that telemedicine could increase access to vascular surgical services, reduce in-person outpatient attendance, reduce non-attendance rates, reduce both patient and hospital costs, and ensure that those patients who did require in-person consultations had sufficient dedicated time, all while maintaining patient satisfaction, adoption rates for telemedicine was low overall, in part due to the absence of relevant legislative and reimbursement protocols. 32,33,37 Nonetheless, in the years immediately prior to the COVID-19 pandemic, the development and implementation of telemedicine clinics was increasingly reported.…”

Section: Discussionmentioning

confidence: 99%

“…32,33,37 Despite data that telemedicine could increase access to vascular surgical services, reduce in-person outpatient attendance, reduce non-attendance rates, reduce both patient and hospital costs, and ensure that those patients who did require in-person consultations had sufficient dedicated time, all while maintaining patient satisfaction, adoption rates for telemedicine was low overall, in part due to the absence of relevant legislative and reimbursement protocols. 32,33,37 Nonetheless, in the years immediately prior to the COVID-19 pandemic, the development and implementation of telemedicine clinics was increasingly reported. In vascular surgery, the use of telemedicine in the management of patients with chronic venous ulcers, diabetic ulcers, peripheral arterial disease and chronic venous insufficiency had been reported.…”

Section: Discussionmentioning

confidence: 99%

Establishment of a clinical nurse specialist-led, virtual aneurysm surveillance clinic

et al. 2022

View full text Add to dashboard Cite

Background The COVID-19 pandemic has necessitated significant changes to the manner in which healthcare is delivered. Chief among these has been the need to rapidly adopt virtual, or telephone clinics as a means of reducing unnecessary patient exposure to hospitals and clinical care settings. We were greatly aided in our adoption of virtual clinics by our experience in the establishment and maintenance of a Clinical Nurse Specialist-led, virtual clinic for both abdominal aortic (AAA) and extra-aortic aneurysm (EAA) surveillance within our department since 2016. Patients undergoing surveillance for abdominal aortic aneurysm (AAA) require frequent and lifelong clinical review. Previous studies have shown that post-operative surveillance in particular is critical in prolonging survival in AAA patients and in the early detection of late complications particularly following endovascular repair (EVAR). Poor compliance with EVAR surveillance has been shown to result in worse outcomes Aim The aim of this study was to evaluate the success of a nurse-led virtual clinic programme in terms of the safe management of patients undergoing AAA surveillance in a nurse-led virtual clinic. Results Over the course of the 4-year period from 2016 to 2019, 1352 patients were enrolled in the virtual aneurysm surveillance clinic. The majority of patients each year were male, ranging from 78.2% in 2016 to 85.2% in 2017. The majority of patients encountered the service owing to pre-operative surveillance of an AAA, with this group comprising at least 65% of the total cohort of patients each year. Over the course of the 4-year period of the virtual clinic there were 1466 patient encounters. Each ambulatory day care centre (ADCC) attendance normally costs the hospital €149. Therefore, a total saving of €218,434 resulted from this initiative alone. No patient presented as an emergency with a ruptured aneurysm during the time period studied. Conclusion Patients with AAA can be safely kept under surveillance in a nurse-led virtual clinic. Our experience with this model of care proved to be particularly advantageous during the period of the early COVID-19 pandemic.

show abstract

“…Wound management can impose substantial costs on both patients and health systems owing to the need for frequent home health visits for dressing changes and the high expenses associated with caring for wound complications [11]. Specifically for wound care, telehealth services delivered by nurses may predict reduced acute care use [10,[12][13][14][15].…”

Section: Telehealth In Specialized Care Settingsmentioning

confidence: 99%

“…Limitations of current telehealth care include the lack of tactile assessment, potential poor resolution and image quality, and additional time and effort needed to instruct patients (eg, on obtaining clinically useful images) [ 7 , 9 ]. Indeed, some successful telehealth interventions have not allowed nurses to work remotely or patients to receive on-demand care [ 12 , 13 , 15 ]. For example, telehealth may require an in-person nurse to be present for tactile assessment or may require patients to travel to facilities with specialized equipment for capturing wound images [ 12 , 13 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

A Nurse-Led Care Delivery App and Telehealth System for Patients Requiring Wound Care: Mixed Methods Implementation and Evaluation Study

Brown‐Johnson¹,

Lessios²,

Thomas³

et al. 2023

JMIR Form Res

View full text Add to dashboard Cite

Background Innovative solutions to nursing care are needed to address nurse, health system, patient, and caregiver concerns related to nursing wellness, work flexibility and control, workforce retention and pipeline, and access to patient care. One innovative approach includes a novel health care delivery model enabling nurse-led, off-hours wound care (PocketRN) to triage emergent concerns and provide additional patient health education via telehealth. Objective This pilot study aimed to evaluate the implementation of PocketRN from the perspective of nurses and patients. Methods Patients and part-time or per-diem, wound care–certified and generalist nurses were recruited through the Stanford Medicine Advanced Wound Care Center in 2021 and 2022. Qualitative data included semistructured interviews with nurses and patients and clinical documentation review. Quantitative data included app use and brief end-of-interaction in-app satisfaction surveys. Results This pilot study suggests that an app-based nursing care delivery model is acceptable, clinically appropriate, and feasible. Low technology literacy had a modest effect on initial patient adoption; this barrier was addressed with built-in outreach and by simplifying the patient experience (eg, via phone instead of video calls). This approach was acceptable for users, despite total patient enrollment and use numbers being lower than anticipated (N=49; 17/49, 35% of patients used the app at least once beyond the orientation call). We interviewed 10 patients: 7 who had used the app were satisfied with it and reported that real-time advice after hours reduced anxiety, and 3 who had not used the app after enrollment reported having other resources for health care advice and noted their perception that this tool was meant for urgent issues, which did not occur for them. Interviewed nurses (n=10) appreciated working from home, and they reported comfort with the scope of practice and added quality of care facilitated by video capabilities; there was interest in additional wound care–specific training for nonspecialized nurses. Nurses were able to provide direct patient care over the web, including the few participating nurses who were unable to perform in-person care (n=2). Conclusions This evaluation provides insights into the integration of technology into standard health care services, such as in-clinic wound care. Using in-system nurses with access to electronic medical records and specialized knowledge facilitated app integration and continuity of care. This care delivery model satisfied nurse desires for flexible and remote work and reduced patient anxiety, potentially reducing postoperative wound care complications. Feasibility was negatively impacted by patients’ technology literacy and few language options; additional patient training, education, and language support are needed to support equitable access. Adoption was impacted by a lack of perceived need for additional care; lower-touch or higher-acuity settings with a longer wait between visits could be a better fit for this type of nurse-led care.

show abstract

An Integrated Nursing and Telemedicine Approach to Vascular Care

Cited by 5 publications

References 5 publications

Feasibility and acceptance of telemedicine for wound care in patients with chronic leg ulcers

Feasibility and acceptance of telemedicine for wound care in patients with chronic leg ulcers

Establishment of a clinical nurse specialist-led, virtual aneurysm surveillance clinic

A Nurse-Led Care Delivery App and Telehealth System for Patients Requiring Wound Care: Mixed Methods Implementation and Evaluation Study

Contact Info

Product

Resources

About