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Assessing patient safety in a pediatric telemedicine setting: a multi-methods study
BACKGROUND: Telemedicine and telephone-triage may compromise patient safety, particularly if urgency is underestimated. We aimed to explore the level of safety of a pediatric telemedicine service, with particular reference to the appropriateness of the medical diagnoses made by the online physicians...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7126468/ https://www.ncbi.nlm.nih.gov/pubmed/32245469 http://dx.doi.org/10.1186/s12911-020-1074-7 |
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author | Haimi, Motti Brammli-Greenberg, Shuli Baron-Epel, Orna Waisman, Yehezkel |
author_facet | Haimi, Motti Brammli-Greenberg, Shuli Baron-Epel, Orna Waisman, Yehezkel |
author_sort | Haimi, Motti |
collection | PubMed |
description | BACKGROUND: Telemedicine and telephone-triage may compromise patient safety, particularly if urgency is underestimated. We aimed to explore the level of safety of a pediatric telemedicine service, with particular reference to the appropriateness of the medical diagnoses made by the online physicians and the reasonableness of their decisions. METHODS: This retrospective multi-method study investigated the decision-making process of physicians in a pediatric tele-triage service provided in Israel. The first section of the study investigates several measures relating to patient safety in the telemedicine setting. Two physicians reviewed a random sample of 339 parent-physician consultations conducted via a pediatric telemedicine service provided by a healthcare organization during 2014–2017. The consultations were analyzed for factors that may have affected the online physicians’ decisions, with an emphasis on the appropriateness of the diagnoses and the reasonableness of the decisions. The online physicians’ decisions were also compared to the subsequent outcomes (i.e., parental compliance with the recommendations and medical follow-ups within the healthcare system) after each consultation. The second section of the study (using a qualitative approach) consisted of interviews with 15 physicians who work in the pediatric telemedicine service, in order to explore their subjective experiences and efforts for assuring patient safety. The physicians were asked about factors that may have affected their reaching an appropriate diagnosis and a reasonable decision while maintaining patient safety. RESULTS: The first section of the study demonstrates high levels of diagnosis appropriateness (98.5%) and decision reasonableness (92%), as well as low levels of false-positive (2.65%) and false-negative (5.3%), good sensitivity (82.85%), and high specificity (96.15%). A high association between the online decisions and the subsequent outcomes was also observed. The second section of the study presents physicians’ means for ensuring high patient safety – by implementing a range of factors that helped them reach appropriate diagnoses and reasonable decisions. CONCLUSIONS: The results show overall high patient safety in the pediatric tele-triage service that was examined. However, decision makers must strive to implement additional means for further enhancing the clinicians’ ability to reach accurate diagnoses and provide optimal treatments within the tele-triage settings – with the aim of ensuring patient safety. |
format | Online Article Text |
id | pubmed-7126468 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-71264682020-04-10 Assessing patient safety in a pediatric telemedicine setting: a multi-methods study Haimi, Motti Brammli-Greenberg, Shuli Baron-Epel, Orna Waisman, Yehezkel BMC Med Inform Decis Mak Research Article BACKGROUND: Telemedicine and telephone-triage may compromise patient safety, particularly if urgency is underestimated. We aimed to explore the level of safety of a pediatric telemedicine service, with particular reference to the appropriateness of the medical diagnoses made by the online physicians and the reasonableness of their decisions. METHODS: This retrospective multi-method study investigated the decision-making process of physicians in a pediatric tele-triage service provided in Israel. The first section of the study investigates several measures relating to patient safety in the telemedicine setting. Two physicians reviewed a random sample of 339 parent-physician consultations conducted via a pediatric telemedicine service provided by a healthcare organization during 2014–2017. The consultations were analyzed for factors that may have affected the online physicians’ decisions, with an emphasis on the appropriateness of the diagnoses and the reasonableness of the decisions. The online physicians’ decisions were also compared to the subsequent outcomes (i.e., parental compliance with the recommendations and medical follow-ups within the healthcare system) after each consultation. The second section of the study (using a qualitative approach) consisted of interviews with 15 physicians who work in the pediatric telemedicine service, in order to explore their subjective experiences and efforts for assuring patient safety. The physicians were asked about factors that may have affected their reaching an appropriate diagnosis and a reasonable decision while maintaining patient safety. RESULTS: The first section of the study demonstrates high levels of diagnosis appropriateness (98.5%) and decision reasonableness (92%), as well as low levels of false-positive (2.65%) and false-negative (5.3%), good sensitivity (82.85%), and high specificity (96.15%). A high association between the online decisions and the subsequent outcomes was also observed. The second section of the study presents physicians’ means for ensuring high patient safety – by implementing a range of factors that helped them reach appropriate diagnoses and reasonable decisions. CONCLUSIONS: The results show overall high patient safety in the pediatric tele-triage service that was examined. However, decision makers must strive to implement additional means for further enhancing the clinicians’ ability to reach accurate diagnoses and provide optimal treatments within the tele-triage settings – with the aim of ensuring patient safety. BioMed Central 2020-04-03 /pmc/articles/PMC7126468/ /pubmed/32245469 http://dx.doi.org/10.1186/s12911-020-1074-7 Text en © The Author(s). 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Article Haimi, Motti Brammli-Greenberg, Shuli Baron-Epel, Orna Waisman, Yehezkel Assessing patient safety in a pediatric telemedicine setting: a multi-methods study |
title | Assessing patient safety in a pediatric telemedicine setting: a multi-methods study |
title_full | Assessing patient safety in a pediatric telemedicine setting: a multi-methods study |
title_fullStr | Assessing patient safety in a pediatric telemedicine setting: a multi-methods study |
title_full_unstemmed | Assessing patient safety in a pediatric telemedicine setting: a multi-methods study |
title_short | Assessing patient safety in a pediatric telemedicine setting: a multi-methods study |
title_sort | assessing patient safety in a pediatric telemedicine setting: a multi-methods study |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7126468/ https://www.ncbi.nlm.nih.gov/pubmed/32245469 http://dx.doi.org/10.1186/s12911-020-1074-7 |
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