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Assessing patient safety in a pediatric telemedicine setting: a multi-methods study
Motti Haimi1,2,3,4, Shuli Brammli-Greenberg5, Orna Baron-Epel5
1Clalit Health Services, Digital Health Wing, Central Division, Tel Aviv, Israel. morx@netvision.net.il.
Insights
Pediatric telemedicine services demonstrate high patient safety, with appropriate diagnoses and reasonable decisions. Continuous improvement is recommended to further enhance accuracy and patient care in tele-triage settings.
Area of Science:
- Pediatric healthcare
- Telemedicine
- Patient safety
Background:
- Telemedicine and telephone triage may pose risks to patient safety if urgency is underestimated.
- Assessing the safety of pediatric telemedicine is crucial, focusing on diagnostic accuracy and decision-making reasonableness.
Purpose of the Study:
- To explore the patient safety level of a pediatric telemedicine service.
- To evaluate the appropriateness of medical diagnoses and reasonableness of decisions made by online physicians.
Main Methods:
- A retrospective multi-method study was conducted on a pediatric telemedicine service in Israel.
- 339 parent-physician consultations were reviewed for diagnostic appropriateness and decision reasonableness, comparing decisions to subsequent outcomes.
- 15 physicians were interviewed to explore their experiences and strategies for ensuring patient safety in tele-triage.
Main Results:
- High diagnosis appropriateness (98.5%) and decision reasonableness (92%) were observed.
- Low false-positive (2.65%) and false-negative (5.3%) rates, with good sensitivity (82.85%) and high specificity (96.15%).
- A strong correlation was found between online decisions and subsequent patient outcomes.
Conclusions:
- The examined pediatric tele-triage service demonstrates overall high patient safety.
- Further enhancements are needed to improve clinicians' diagnostic accuracy and treatment optimization in telemedicine settings to ensure patient safety.
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.
