Fifteen-minute consultation: A practical approach to remote consultations for paediatric patients during the COVID-19 pandemic

Galway, Niamh; Stewart, Gemma; Maskery, Julia; Bourke, Thomas; Lundy, Claire Teresa

doi:10.1136/archdischild-2020-320000

Cited by 10 publications

(9 citation statements)

References 12 publications

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“…Guidance for conducting video consultations were initially produced based on early examples of implementation [16][17][18][19][20][21][22]. More definitive guidance was later developed, based on learning during the pandemic, with the view of informing best practices beyond COVID-19 [23][24][25][26].…”

Section: Video Consulting Before During and Beyond The Pandemicmentioning

confidence: 99%

The Role of Information Infrastructures in Scaling up Video Consultations During COVID-19: Mixed Methods Case Study Into Opportunity, Disruption, and Exposure

Wherton¹,

Greenhalgh²,

Hughes³

et al. 2022

J Med Internet Res

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Background Until COVID-19, implementation and uptake of video consultations in health care was slow. However, the pandemic created a “burning platform” for scaling up such services. As health care organizations look to expand and maintain the use of video in the “new normal,” it is important to understand infrastructural influences and changes that emerged during the pandemic and that may influence sustainability going forward. Objective This study aims to draw lessons from 4 National Health Service (NHS) organizations on how information infrastructures shaped, and were shaped by, the rapid scale-up of video consultations during COVID-19. Methods A mixed methods case study of 4 NHS trusts in England was conducted before and during the pandemic. Data comprised 90 interviews with 49 participants (eg, clinicians, managers, administrators, and IT support), ethnographic field notes, and video consultation activity data. We sought examples of infrastructural features and challenges related to the rapid scale-up of video. Analysis was guided by Gkeredakis et al’s 3 perspectives on crisis and digital change: as opportunity (for accelerated innovation and removal of barriers to experimentation), disruption (to organizational practices, generating new dependencies and risks), and exposure (of vulnerabilities in both people and infrastructure). Results Before COVID-19, there was a strong policy push for video consultations as a way of delivering health care efficiently. However, the spread of video was slow, and adopting clinicians described their use as ad hoc rather than business as usual. When the pandemic hit, video was rapidly scaled up. The most rapid increase in use was during the first month of the pandemic (March-April 2020), from an average of 8 video consultations per week to 171 per week at each site. Uptake continued to increase during the pandemic, averaging approximately 800 video consultations per week by March 2021. From an opportunity perspective, participants talked about changes to institutional elements of infrastructure, which had historically restricted the introduction and use of video. This was supported by an “organizing vision” for video, bringing legitimacy and support. Perspectives on disruption centered on changes to social, technical, and material work environments and the emergence of new patterns of action. Retaining positive elements of such change required a judicious balance between managerial (top-down) and emergent (bottom-up) approaches. Perspectives on exposure foregrounded social and technical impediments to video consulting. This highlighted the need to attend to the materiality and dependability of the installed base, as well as the social and cultural context of use. Conclusions For sustained adoption at scale, health care organizations need to enable incremental systemic change and flexibility through agile governance and knowledge transfer pathways, support process multiplicity within virtual clinic workflows, attend to the materiality and dependability of the IT infrastructure within and beyond organizational boundaries, and maintain an overall narrative within which the continued use of video can be framed.

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Section: Video Consulting Before During and Beyond The Pandemicmentioning

confidence: 99%

The Role of Information Infrastructures in Scaling up Video Consultations During COVID-19: Mixed Methods Case Study Into Opportunity, Disruption, and Exposure

Wherton¹,

Greenhalgh²,

Hughes³

et al. 2022

J Med Internet Res

View full text Add to dashboard Cite

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“…During the COVID-19 pandemic, clinical consultations were often conducted online to minimise potential viral spread 20. As part of the paediatric medical student education programme in Queens University Belfast, we facilitated virtual bedside teaching sessions.…”

Section: Adapting To the Covid-19 Pandemicmentioning

confidence: 99%

“…This allowed medical students the opportunity to join virtual ward rounds and conduct history-taking from paediatric inpatients and their families, while limiting face-to-face exposure. This received excellent student feedback and it is apparent that many patients and parents prefer virtual consultations 20…”

Section: Adapting To the Covid-19 Pandemicmentioning

confidence: 99%

Patient and public involvement in paediatric medical education

Donnelly

Ferris

Bourke

et al. 2022

Arch Dis Child Educ Pract Ed

Self Cite

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The benefits of involving patients and the public in medical education are well documented, however there is a need to further explore how this can be translated to the setting of paediatric medical education. This article aims to identify how organisations can facilitate the involvement of paediatric patients and their parents/carers.While involving children in research can present challenges, we describe examples where organisations have successfully involved young people in clinical research and selection of research topics.Involving paediatric patients and their parents/carers in medical education helps develop a patient centred approach to practice for medical students. Participation of paediatric patients in objective structured clinical examination (OSCE) examinations is employed by many medical schools, however allowing them the ability to provide a ‘global score’ may have the potential to assess skills such as communication and empathy in addition to medical knowledge.The Royal College of Paediatrics and Child Health (RCPCH) have provided a framework on how to involve children in health services, addressing practical considerations such as funding and facilities. This framework could be applied by organisations seeking to actively involve children in paediatric medical education. Potential barriers and facilitators are explored in this article.During the COVID-19 pandemic, involving young people and their families in medical student teaching became challenging. We describe virtual bedside teaching sessions which actively involved paediatric patients and their families, which showed that many patients and parents prefer virtual consultations.Involving paediatric patients and their families in medical education is strongly advocated by the General Medical Council (GMC) and RCPCH. Organisations should actively seek out opportunities to become involved in the development of medical education resources as we describe in this paper.

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“…VC can adversely affect the flow of the conversation [40] which may impact a clinicians attempt to undertake a thorough subjective assessment. Poor internet connection is commonly reported [41] and interferes with transmission of information [42].…”

Section: Safeguarding Issuesmentioning

confidence: 99%

A mixed-methods survey to explore issues with virtual consultations for musculoskeletal care during the COVID-19 pandemic

Gilbert

Booth

Betts

et al. 2021

BMC Musculoskelet Disord

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Objective To explore orthopaedic and musculoskeletal clinicians’ views and experiences of legal, safety, safeguarding and security issues regarding the use of virtual consultations (VC) during the COVID-19 pandemic. A secondary objective was to suggest ways to overcome these issues. Methods A mixed method cross-sectional survey was conducted, seeking the views and experiences of orthopaedic and musculoskeletal medically qualified and Allied Health Professionals in the United Kingdom. Descriptive statistical analysis was employed for quantitative data and a qualitative content analysis undertaken for qualitative data. Findings were presented in accordance with the four key issues. Results Two hundred and ninety professionals (206 physiotherapists, 78 medically qualified professionals, 6 ‘other’ therapists) participated in the survey. Of the 290 participants, 260 (90%) were not using VC prior to the COVID-19 pandemic, 248 respondents (86%) were unsure whether their professional indemnity insurance covered VC, 136 (47%) had considered how they would handle an issue of safeguarding whilst the remainder had not, 126 (43%) had considered what they would do if, during a virtual consultation, a patient suffered an injury (e.g. bang on their head) or a fall (e.g. mechanical or a medical event like syncope) and 158 (54%) reported they felt the current technological solutions are secure in terms of patient data. Qualitative data provided additional context to support the quantitative findings such as validity of indemnification, accuracy of diagnosis and consent using VC, safeguarding issues; and security and sharing of data. Potential changes to practice have been proposed to address these issues. Conclusions VC have been rapidly deployed since the onset of the COVID-19 pandemic often without clear guidance or consensus on many important issues. This study identified legal, safeguarding, safety and security issues. There is an urgent need to address these and develop local and national guidance and frameworks to facilitate ongoing safe virtual orthopaedic practice beyond the COVID-19 pandemic.

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Fifteen-minute consultation: A practical approach to remote consultations for paediatric patients during the COVID-19 pandemic

Cited by 10 publications

References 12 publications

The Role of Information Infrastructures in Scaling up Video Consultations During COVID-19: Mixed Methods Case Study Into Opportunity, Disruption, and Exposure

The Role of Information Infrastructures in Scaling up Video Consultations During COVID-19: Mixed Methods Case Study Into Opportunity, Disruption, and Exposure

Patient and public involvement in paediatric medical education

A mixed-methods survey to explore issues with virtual consultations for musculoskeletal care during the COVID-19 pandemic

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