Impact of telemedicine in hospital culture and its consequences on quality of care and safety

Abstract

Objective To describe the impact of the telemedicine application on the clinical process of care and its different effects on hospital culture and healthcare practice.Methods The concept of telemedicine through real time audio-visual coverage was implemented at two different hospitals in São Paulo: a secondary and public hospital, Hospital Municipal Dr. Moysés Deutsch, and a tertiary and private hospital, Hospital Israelita Albert Einstein.Results Data were obtained from 257 teleconsultations records over a 12-month period and were compared to a similar period before telemedicine implementation. For 18 patients (7.1%) telemedicine consultation influenced in diagnosis conclusion, and for 239 patients (92.9%), the consultation contributed to clinical management. After telemedicine implementation, stroke thrombolysis protocol was applied in 11% of ischemic stroke patients. Telemedicine approach reduced the need to transfer the patient to another hospital in 25.9% regarding neurological evaluation. Sepsis protocol were adopted and lead to a 30.4% reduction mortality regarding severe sepsis.Conclusion The application is associated with differences in the use of health services: emergency transfers, mortality, implementation of protocols and patient management decisions, especially regarding thrombolysis. These results highlight the role of telemedicine as a vector for transformation of hospital culture impacting on the safety and quality of care.

A Importância Da Telemedicina No Contexto Da Pandemia De Covid-19

“…As especialidades encontradas são Telerradiologia, Telepatologia, Teledermatologia, Teleoftalmologia, Telecirurgia (URTIGA, 2011). A experiência da telemedicina é aplicada em outras áreas ao campo da medicina de emergência (STEINMAN et al, 2015).…”

Robot-assisted surgical ward rounds: virtually always there

“…Greatest reduction in LOS is noted in ICU settings with ‘direct intervention’ approaches where the telemedicine provider proactively makes decisions and communicated to bedside providers, and with strategies incorporating multi-disciplinary team rounding;62 this is an approach routinely mirrored by conventional and RASWR in our institution. Outside of the ICU setting, benefits of telemedicine in reducing time to senior decision-making resulting in expedited investigation or delivery of definitive care has been described 63. While one might instinctively have concerns regarding integrity of messages and instructions communicated between staff via a telepresence device, a large study amongst nursing staff in the ICU suggests that telemedicine improves communication and collaboration between senior doctors and nurses, facilitating efficient and effective delivery of patient care 64.…”

Implementation of integration strategies between primary care units and a regional general hospital in Brazil to update and connect health care professionals: a quasi-experimental study protocol

“…These patients will then visit HMMD, where they will be seen by an HIAE physician or nurse specialist via telemedicine equipment. This is an ongoing project supported by the HIAE and the Ministry of Health, with benefits reported among patients seen in the HMMD emergency room [ 19 ]. Clinical management updating DLC A DLC based on the Brazilian ACSC criteria, focusing on physicians, nurses, and multi-professional staff, will be implemented.…”

“…These patients will then visit HMMD, where they will be seen by an HIAE physician or nurse specialist via telemedicine equipment. This is an ongoing project supported by the HIAE and the Ministry of Health, with benefits reported among patients seen in the HMMD emergency room [ 19 ].…”