Department of Pediatrics, University of California Davis, Sacramento, CA.
Center for Healthcare Policy and Research, University of California Davis, Sacramento, CA.
Acad Emerg Med. 2019 Sep;26(9):1022-1033. doi: 10.1111/acem.13763. Epub 2019 May 2.
Pediatric emergency telemedicine consultations have been shown to provide support to community emergency departments treating critically ill pediatric patients. However, despite the recognized value of telemedicine, adoption has been slow. To determine why clinicians frequently do not use telemedicine when it is available for pediatric patients, as well as to learn how to improve telemedicine programs, we conducted a qualitative study using stakeholder interviews.
We conducted a qualitative study using grounded theory methodology, with in-depth interviews of referring and accepting physicians and referring, transport, and transfer center nurses. We analyzed data iteratively and adapted the interview guide based on early interviews. We solicited feedback from the participants on the conceptual model.
Sixteen interviews were conducted; all respondents had been involved in a telemedicine consultation at least five times, with some having used telemedicine more than 30 times. Analysis resulted in three themes: 1) recognizing and addressing telemedicine biases are central to gaining buy-in; 2) as technology advances, telemedicine processes need to adapt accordingly; and 3) telemedicine increases collaboration among health care providers and patients/families in the patient care process.
To improve patient care through increased use of telemedicine for pediatric emergency consultations, processes need to be modified to address provider biases and end-user concerns. Processes should be adapted to allow users to utilize a variety of technologies (including smartphones) and to enable more users, such as nurses, to participate. Finally, telemedicine can be used to improve the patient and family experience by including them in consultations.
儿科急诊远程医疗咨询已被证明可以为治疗危重新生儿的社区急诊部门提供支持。然而，尽管远程医疗的价值得到了认可，但采用速度却很慢。为了确定为什么临床医生在有儿科患者远程医疗服务时经常不使用它，以及了解如何改进远程医疗计划，我们使用利益相关者访谈进行了一项定性研究。
我们使用扎根理论方法进行了一项定性研究，对转诊和接诊医生以及转诊、转运和转院中心护士进行了深入访谈。我们对数据进行了迭代分析，并根据早期访谈调整了访谈指南。我们就概念模型向参与者征求了反馈意见。
共进行了 16 次访谈；所有受访者都至少进行了 5 次远程医疗咨询，有些受访者进行了 30 多次远程医疗咨询。分析结果产生了三个主题：1）认识和解决远程医疗偏见是获得认可的核心；2）随着技术的进步，远程医疗流程需要相应地进行调整；3）远程医疗增加了医疗保健提供者之间以及患者/家属在患者护理过程中的协作。
为了通过增加儿科急诊咨询的远程医疗使用来改善患者护理，需要修改流程以解决提供者偏见和最终用户的担忧。流程应进行调整，以允许用户使用各种技术（包括智能手机），并使更多的用户（如护士）能够参与。最后，通过让患者和家属参与咨询，远程医疗可以改善患者和家属的体验。
