Tablet telerounding

Telepresence Robots at the Urology and Emergency Department: A Pilot Study Assessing Patients’ and Healthcare Workers’ Satisfaction

COVID-19 intensified interest in telemedicine, yet no study has evaluated the use of a telepresence robot on unselected urological patients. Therefore, we performed a survey study of patients, bedside caregivers and urologists, investigating the satisfaction and applicability of a telepresence robot (Beam Pro, Suitable Technologies, USA) at the urology ward and emergency department. The primary outcome was the number of patient encounters solved without the urologist's physical presence. Between March 2021 and May 2021, patients, caregivers, and urologists filled in 42, 35, and 54 questionnaires, respectively. Most patients were male (79%), with a mean age of 64 (SD ± 17). Two of the department's ten urologists participated. The urologists responded that physical examination was required in 7 (13%) encounters. The caregivers would have preferred the urologist physically present in 11 (31%) cases. Most patients (71%) “agreed” or “strongly agreed” that they were willing to be attended by a telepresence robot at future evaluations and generally, patients gave high satisfaction scores. Though implementation among the department's urologists was a major challenge, participating urologists reported that physical presence could be avoided in 87% of the patient encounters. Studies of patient-reported outcome measures comparing telemedical and physical patient encounters are needed.

The impact of COVID-19 on urology office visits and adoption of telemedicine services

PURPOSE OF REVIEW

The purpose of this review article is to discuss the impact of Coronavirus Disease 2019 (COVID-19) on the evolution of telemedicine use for urology office visits.

RECENT FINDINGS

The COVID-19 pandemic has caused a dramatic change in the delivery of healthcare. Fraught with numerous barriers previously, the need for healthcare delivery during a time of social distancing and increased healthcare requirements drove the adoption of telemedicine forward. This 'trial period' over the last year has allowed us to appreciate the potential utility of telehealth-associated services in practice and consider its role even after the pandemic. Multiple studies equating its utility to in-person visits whereas simultaneously providing added convenience and cost-related savings have been published in the urologic literature. Permanent regulatory changes will need to be implemented to allow us the flexibility to use telehealth in the future.

SUMMARY

It is clear that telemedicine is an effective strategy for delivery of healthcare under the right circumstances. Although it initially started to fill a need out of necessity, it can help us effectively deliver healthcare as long as the regulations surrounding telemedicine allow us to continue to use it. This period has been challenging for healthcare delivery and led to policy changes that served as a catalyst to help us better understand this previously underutilized resource.

Telerounding: A scoping review and implications for future healthcare practice

Introduction

Telerounding is slated to become an important avenue for future healthcare practice. As utilization of telerounding is increasing, a review of the literature is necessary to distill themes and identify critical considerations for the implementation of telerounding. We provide evidence of the utility of telerounding and considerations to support its implementation in future healthcare practice based on a scoping review.

Method

We collected articles from nine scientific databases from the earliest dated available articles to August 2020. We identified whether each article centered on telerounding policies, regulations, or practice. We also organized information from each article and sorted themes into four categories: sample characteristics, technology utilized, study constructs, and research outcomes.

Results

We identified 21 articles related to telerounding that fit our criteria. All articles emphasized telerounding practice. Most articles reported data collected from surgical wards, had adult samples, and utilized robotic telerounding systems. Most articles reported null effects or positive effects on their measured variables.

Discussion

Providers and patients can benefit from the effective implementation of telerounding. Telerounding can support patient care by reducing travel expenses and opportunities for infection. Evidence suggests that telerounding can reduce patient length of stay. Patients and providers are willing to utilize telerounding, but patient willingness is influenced by age and education. Telerounding does not appear to negatively impact satisfaction or patient care. Organizations seeking to implement telerounding systems must consider education for their providers, logistics associated with hardware and software, scheduling, and characteristics of the organizational context that can support telerounding. Considerations provided in this article can mitigate difficulties associated with the implementation of telerounding.

Challenges of Using Instant Communication Technology in the Emergency Department during the COVID-19 Pandemic: A Focus Group Study

A record outbreak of community-spread COVID-19 started on 10 May 2021, in Taiwan. In response to the COVID-19 pandemic, care facilities have adopted various protocols using instant communication technology (ICT) to provide remote yet timely healthcare while ensuring staff safety. The challenges of patient evaluation in the emergency department (ED) using ICT are seldom discussed in the literature. The objective of this study was to investigate the factors influencing the utility of ICT for patient assessment in emergency settings during the pandemic. The patient flow protocol and the ED layout were modified and regionalized into different areas according to the patient’s risk of COVID-19 infection. Nine iPads were stationed in different zones to aid in virtual patient assessment and communication between medical personnel. A focus group study was performed to assess and analyze the utility of the ICT module in the ED. Eight emergency physicians participated in the study. Of them, four (50%) had been directly involved in the development of the ICT module in the study hospital. Three main themes that influenced the application of the ICT module were identified: setting, hardware, and software. The setting theme included six factors: patient evaluation, subspecialty consultation, patient privacy and comfortableness, sanitation, cost, and patient acceptability. The hardware theme included six factors: internet connection, power, quality of image and voice, public or personal mode, portable or fixed mode, and maintenance. The software theme included six factors: platform choices, security, ICT accounts, interview modes, video/voice recording, and time limitation. Future studies should focus on quantifying module feasibility, user satisfaction, and protocol adjustment for different settings.

Telerounding Has Clinical Value and Enables the Busy Surgeon: A Colorectal Surgeon's Ten-Year Experience

BACKGROUND

Study of telemedicine and telerounding in surgical specialties is limited. The push for telemedicine during the COVID-19 pandemic has challenged the face-to-face rounding paradigm and creates an opportunity for reflection on the benefits of telemedicine, especially for balancing competing corporate and clinical demands.

METHODS

The 117-month video-based inpatient telerounding experience of a colorectal surgeon in an academic medical system was recorded, including patient characteristics, diagnoses, technology, content of telerounding encounters, and logistical considerations. Data were analyzed using descriptive statistics.

RESULTS

163 patients were seen in 201 telerounding encounters, primarily for routine postoperative care (90.5%). Most were admitted for inflammatory bowel disease (63.2%). Changes were made to plans of care during 28.9% of encounters, and discharge planning was part of 26.4%. Encounters were conducted primarily from the surgeon's administrative office (68.7%) or other work-related locations (10.9%), while 6.5% originated from the surgeon's home. Technologic issues occurred in 5.5% of encounters. 89.1% of patient feedback was positive and none was negative.

CONCLUSION

Telerounding is technologically feasible and has clinical value, including for patients with complex surgical problems. Technologic problems are rare and patient satisfaction is high. Surgeons should consider telerounding as a means to balance competing demands.

Telerounding Offers High Patient Satisfaction After Total Joint Arthroplasty

BACKGROUND

Research in surgical fields other than orthopedics has demonstrated high patient satisfaction with non-traditional telerounding modalities.

QUESTIONS/PURPOSES

We sought to determine patient satisfaction and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores of patients who experienced telerounding in the post-operative period after undergoing total joint arthroplasty (TJA).

METHODS

Fifty consecutive TJA patients were prospectively enrolled to receive telerounding. The patients were divided into two groups based on their satisfaction with telerounding. The HCAHPS scores of the patients who received telerounding were compared with 50 control patients.

RESULTS

Overall, the telerounding cohort had a positive reaction to telerounding. Comparing patients who were highly satisfied to those who were dissatisfied with telerounding, younger patients were found to be more frequently satisfied with telerounding. Compared with patients who did not receive telerounding, patients who experienced telerounding rated the hospital higher on a 10-point scale were more likely to recommend the hospital to others, more frequently believed their physicians treated them with courtesy and respect, and more often believed their physicians always listened to them carefully.

CONCLUSION

An overwhelming majority of our patients found telerounding using FaceTime enhanced their care while recovering post-operatively from TJA. Those patients were typically younger and had significantly higher HCAHPS scores, which potentially can enhance the physician-patient relationship.

Rapid Deployment of Inpatient Telemedicine In Response to COVID-19 Across Three Health Systems

OBJECTIVE

To reduce pathogen exposure, conserve personal protective equipment, and facilitate health care personnel work participation in the setting of the COVID-19 pandemic, three affiliated institutions rapidly and independently deployed inpatient telemedicine programs during March 2020. We describe key features and early learnings of these programs in the hospital setting.

METHODS

Relevant clinical and operational leadership from an academic medical center, pediatric teaching hospital, and safety net county health system met to share learnings shortly after deploying inpatient telemedicine. A summative analysis of their learnings was re-circulated for approval.

RESULTS

All three institutions faced pressure to urgently standup new telemedicine systems while still maintaining secure information exchange. Differences across patient demographics and technological capabilities led to variation in solution design, though key technical considerations were similar. Rapid deployment in each system relied on readily available consumer-grade technology, given the existing familiarity to patients and clinicians and minimal infrastructure investment. Preliminary data from the academic medical center over one month suggested positive adoption with 631 inpatient video calls lasting an average (standard deviation) of 16.5 minutes (19.6) based on inclusion criteria.

DISCUSSION

The threat of an imminent surge of COVID-19 patients drove three institutions to rapidly develop inpatient telemedicine solutions. Concurrently, federal and state regulators temporarily relaxed restrictions that would have previously limited these efforts. Strategic direction from executive leadership, leveraging off-the-shelf hardware, vendor engagement, and clinical workflow integration facilitated rapid deployment.

CONCLUSION

The rapid deployment of inpatient telemedicine is feasible across diverse settings as a response to the COVID-19 pandemic.

Patient Attitudes Toward Mobile Device Use by Health Care Providers in the Emergency Department: Cross-Sectional Survey

BACKGROUND

Health care provider usage of mobile devices is increasing globally; however, there is little understanding of patient perceptions on this behavior in a health care setting.

OBJECTIVE

The aim of this study was to assess patients' attitudes toward mobile device usage by health care providers in the emergency department and to identify predictors of these attitudes.

METHODS

The study was carried out at the emergency department of a large academic tertiary care medical center in Lebanon. A cross-sectional survey design was adopted by administering a questionnaire to medically stable adult patients who presented to the emergency department with an emergency severity index of 3, 4, or 5 between January 2017 and March 2018. The questionnaire collected relevant patient demographic information and included questions related to their mobile device usage along with those evaluating attitudes for the use of mobile devices by health care providers with respect to six major domains: role in health care, distraction potential, impact on communication, empathy, privacy, and professionalism. The attitude toward mobile device usage by health care providers in the emergency department was the main outcome variable. A stepwise logistic regression model was used to assess the association between the outcome variable and the demographic and attitude-related independent variables.

RESULTS

Among the 438 eligible patients, 338 patients responded to the questionnaire for a response rate of 70.0%. Overall, 313/338 (92.6%) respondents agreed that mobile devices improve health care delivery, whereas 132/338 (39.1%) respondents were opposed to their usage by health care providers in the emergency department (95% CI: 34.0-44.4). The majority (240/338, 71.0%) of patients agreed that mobile devices are a source of distraction to health care providers in the workplace. Females (odds ratio [OR]=1.67, 95% CI: 1.00-2.78) as well as all patients (OR=2.54, 95% CI 1.36-4.76) who believed that mobile devices were a source of distraction, reflecting a lack of professionalism (OR=2.77, 95% CI 1.59-4.82) and impacting the provider's ability to relate to the patient (OR=2.93, 95% CI 1.72-4.99), were more likely to agree that mobile devices should not be used in the emergency department.

CONCLUSIONS

Patients' negative attitude toward mobile device use in the emergency department is largely driven by patient gender (females), patient perception of the distraction potential of the devices, and their negative impact on the health care provider's empathy and professionalism. The findings of this study shed light on the importance of encouraging stakeholders to impose a digital professionalism code of conduct for providers working in acute health care settings.

Research on Patient Satisfaction of Robotic Telerounding: A Pilot Study in a Korean Population

OBJECTIVES

To evaluate the efficacy and functionality of robotic telerounding among Korean patients using the RP-7 robot system and a questionnaire survey comparing the results of robotic telerounding and standard rounding in Korean patients.

METHODS

A total of 40 patients who underwent urologic minimally invasive video-assisted minilaparotomy surgery, laparoscopic and robotic surgery, and endoscopic surgery were recruited. The patients were divided into 2 groups - telerounding (20) and standard rounding (20) - and underwent robotic telerounding and standard rounding. We assessed the patients using a 24-item questionnaire to evaluate the efficacy and functionality of their hospital care.

RESULTS

The hospital factors such as self-rated health, assistance, and pain control scores showed no statistically significant differences between groups. Patient satisfaction showed a statistically significant difference in MD confidence, medical communication, explanation understanding, explanation satisfaction, mutual communication, and mutual response. In the telerounding group, participants were satisfied with the audio and video qualities and believed that the robotic telerounding provided better care, and 85% of patients preferred telerounding in the absence of the attending physician.

CONCLUSION

Robotic telerounding can provide efficient and cost-effective medical rounding by reducing inconvenience and labor cost with greater patient satisfaction with postoperative care. However, there is no statistically significant difference in the hospital factors and postoperative morbidity. In addition, the patients doubted that the robotic telerounding could replace standard rounding due to the Eastern culture.

Robot Assisted Surgical Ward Rounds: Virtually Always There

BACKGROUND

 While an explosion in technological sophistication has revolutionized surgery within the operating theatre, delivery of surgical ward-based care has seen little innovation.  Use of telepresence allowing off-site clinicians communicate with patients has been largely restricted to outpatient settings or use of complex, expensive, static devices.  We designed a prospective study to ascertain feasibility and face validity of a remotely controlled mobile audiovisual drone (LUCY) to access inpatients.  This device is, uniquely, lightweight, freely mobile and emulates 'human' interaction by swiveling and adjusting height to patients' eye-level.   METHODS: Robot-assisted ward rounds(RASWR) were conducted over 3 months. A remotely located consultant surgeon communicated with patients/bedside teams via encrypted audiovisual telepresence robot (DoubleRoboticstm, California USA).  Likert-scale satisfaction questionnaires, incorporating free-text sections for mixed-methods data collection, were disseminated to patient and staff volunteers following RASWRs.  The same cohort completed a linked questionnaire following conventional (gold-standard) rounds, acting as control group. Data were paired, and non-parametric analysis performed.  RESULTS: RASWRs are feasible (>90% completed without technical difficulty). The RASWR(n=52 observations) demonstrated face validity with strong correlations (r>0.7; Spearman, p-value <0.05) between robotic and conventional ward rounds among patients and staff on core themes, including dignity/confidentiality/communication/satisfaction with management plan. Patients (96.08%, n=25) agreed RASWR were a satisfactory alternative when consultant physical presence was not possible. There was acceptance of nursing/NCHD cohort (100% (n=11) willing to regularly partake in RASWR).  CONCLUSION: RASWRs receive high levels of patient and staff acceptance, and offer a valid alternative to conventional ward rounds when a consultant cannot be physically present.

The Current State of Telemedicine in Urology

Telemedicine use in urology is an evolving practice. In this article, the authors review the early experience of telemedicine specifically as it relates to urologic practice and discuss the future implications and the utility of telemedicine as it applies to other fields.

Evaluating the Effectiveness, Efficiency and Safety of Telemedicine for Urological Care in the Male Prisoner Population

Introduction

We reviewed the safety and effectiveness of our hospital's urologic telemedicine (TM) program that has been utilized for the Iowa prisoner population for over a decade.

Methods

A retrospective review of TM visits of male prisoners from 2007 to 2014 was performed. Effectiveness of TM visits was assessed by 1) concordance of TM and in-person diagnoses, 2) compliance with radiologic and medication orders and 3) in-person visits saved with TM. Safety was assessed by analyzing the number of patients in which an ED visit was required after TM visit and missed or delayed cases of malignancy. Estimates were then made of the number of patients that could safely be managed with TM alone.

Results

The most common diagnosis was voiding dysfunction (24%) followed by genitourinary pain (23%). Diagnoses were concordant in 90% of patients; compliance was high (radiology 91%, medications 89%); in-person visits were estimated to be saved in 80-94%. No men required peri-TM ED visits and no cases of malignancy were missed in the population that returned for an in-person visit. We estimated that over 50% of urologic complaints in this cohort could have been managed with TM alone.

Conclusions

TM was shown to be a safe and effective method to provide general urologic care that obviated the initial in-person visits in nearly 90% of patients. It is likely that TM could safely replace in-person visits for many urologic conditions, especially in younger men and those in which access to specialized care may be limited.

Telemedicine in Urology: State of the Art

Whereas telemedicine is recognized as one of the fastest-growing components of the healthcare system, the status of telemedicine use in urology is largely unknown. In this narrative review, we detail studies that investigate the use of televisits and teleconsultations for urologic conditions. Moreover, we discuss current regulatory and reimbursement policies. Finally, we discuss the significant barriers to widespread dissemination and implementation of telemedicine and reasons why the field of urology may be positioned to become a leader in the provision of telemedicine services.

Telemedicine in Surgery: What are the Opportunities and Hurdles to Realising the Potential?

Since the first telegraphic transmission of an electrocardiogram in 1906, technological developments have allowed telemedicine to flourish. It has become a multi-billion pound industry encompassing many areas of medical practice and education. Telemedicine is now widely used in surgery from performing operations to teaching and can be divided into three main components; telesurgery, telementoring and teleconsultation. Developments across these fields have led to remarkable achievements such as intercontinental telesurgery and telementoring. However, barriers to the further implementation of telemedicine remain. In this review, the developments and recent advances of telemedicine across the three domains are discussed together with the challenges and limitations that need to be overcome.

Utility of Daily Mobile Tablet Use for Residents on an Otolaryngology Head & Neck Surgery Inpatient Service

The objective of this study was to investigate the utility of electronic tablets and their capacity to increase hospital floor productivity, efficiency, improve patient care information safety, and to enhance resident education and resource utilization on a busy Otolaryngology - Head & Neck Surgery inpatient service. This was a prospective cohort study with a 2-week pre-implementation period with standard paper census lists without mobile tablet use, and a 2-week post-implementation period followed with electronic tablets used to place orders, look up pertinent clinical data, educate patients as appropriate, and to record daily to-dos that would previously be recorded on paper. The setting for the study was Duke University Medical Center in Durham, North Carolina, with 13 Otolaryngology residents comprising the study population. The time for inpatient rounding was shorter with the use tablets (p = 0.037). There was a non-significant trend in the number of times a resident had to leave rounds to look up a clinical query on a computer, with less instances occurring in the post-implementation study period. The residents felt that having a tablet facilitated more detailed and faster transfer of information, and improved ease of documentation in the medical record. Seventy percent felt tablets helped them spend more time with patients, 70 % could spend more time directly involved in rounds because they could use the tablet to query information at point-of-care, and 80 % felt tablets improved morale. The utility of a mobile tablet device coupled with the electronic health record appeared to have both quantitative and qualitative improvements in efficiency, increased time with patients and attendance at academic conferences. Tablets should be encouraged but not mandated for clinical and educational use.

Telemedical technologies in urological cancer care: past, present and future applications

Since the initial development of telegraphy by Sir Charles Wheatstone in 1837 and the telephone by Alexander Graham Bell in 1875, doctors have been able to convey medical information across great distances. The exchange and sharing of medical information has evolved and adapted to suit the vast array of today's medicine. Early adopters of telemedicine within clinical practice have gained significant health economic benefits. The arrival of wireless connections has further enhanced the possibilities for all clinical work with focus on diagnosis, treatment and management of urological cancers, as highlighted in this article.