Abstract

BACKGROUND: The COVID-19 pandemic created new challenges to delivering safe and effective healthcare while minimizing staff and non-COVID-19 patient exposure to the virus. Health systems worldwide have moved quickly to implement telemedicine in diverse settings to reduce infection, but little is understood about how best to connect acutely ill patients with nearby clinical team members, even in the next room.OBJECTIVE: To inform these efforts, this paper provides an early example of inpatient telemedicine implementation and its perceived acceptability and effectiveness.METHODS: Using purposive sampling, this study conducted 15 semi-structured interviews with nurses (n=5) and attending (n=5) and resident (n=15) physicians on a single COVID-19 unit within Stanford Health Care to evaluate implementation outcomes and perceived effectiveness of inpatient telemedicine. Semi-structured interview protocols and qualitative analysis were framed around the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework and identified key themes using a rapid analytic process and consensus approach.RESULTS: All clinical team members reported wide reach of inpatient telemedicine, with some use for almost all COVID-19 patients. Inpatient telemedicine was perceived to be effective in reducing COVID-19 exposure and personal protective equipment (PPE) use without significantly compromising quality of care. Physician workflows remained relatively stable as most standard clinical activities were conducted via telemedicine following the initial intake examination, though resident physicians reported reduced educational opportunities given limited opportunities to conduct physical exams. Nurse workflows required significant adaptations to cover non-nursing duties such as food delivery and facilitating technology connections for patients and physicians alike. Perceived patient impact included consistent care quality, with some considerations around privacy. Reported challenges included: patient-clinical team communication and personal connection with the patient, perceptions of patient isolation, ongoing technical challenges, and certain aspects of the physical exam.CONCLUSIONS: Clinical team members reported inpatient telemedicine encounters as acceptable and effective in reducing COVID-19 exposure and PPE use. Nurses adapted their workflows more than physicians to implement the new technology and bore a higher burden of in-person care and technical support. Recommendations for improved inpatient telemedicine use include information technology (IT) support and training, increased technical functionality, and remote access for the clinical team.CLINICALTRIAL:

View details for DOI 10.2196/26452

View details for PubMedID 34033576