Adverse Events Involving Telehealth in the Veterans Health Administration.

Area of Science:

• Healthcare delivery
• Patient safety
• Telemedicine

Background:

• Telehealth adoption surged during the COVID-19 pandemic, increasing its use in systems like the Veterans Health Administration (VHA).
• While telehealth offers benefits like improved access, it also presents challenges including communication breakdowns and potential diagnostic delays.
• Few studies have comprehensively examined adverse events and patient safety within telehealth services.

Purpose of the Study:

• To analyze adverse events and close calls related to telehealth use within the VHA.
• To identify common types, locations, and causes of telehealth-related safety incidents.
• To assess the frequency and severity of harm associated with telehealth care.

Main Methods:

• A review of all VHA adverse event and close call reports involving telehealth from October 1, 2022, to February 2, 2023.
• Categorization of each incident by event location, type, and contributing factors.
• Calculation of reporting rates per episode of care.

Main Results:

• 145 reports were reviewed, with most events occurring in primary care, behavioral health, and radiology.
• Common issues included care delays, medication errors, and equipment problems; most events did not result in patient harm.
• The overall reporting rate for adverse events was 4.02 per 100,000 telehealth episodes, with 0.42 reports of harm per 100,000 episodes.

Conclusions:

• Telehealth-related adverse events like care delays, medication errors, and equipment issues are infrequent and often not unique to the telehealth modality.
• Further research is necessary to identify and address safety events specific to telehealth.
• Recommendations include enhanced provider training, human factors analysis, simplified technical support, and review of telehealth business rules to improve patient safety.