Provider Impressions of Inpatient Teleneurology Consultation.

IF 2.3 Q3 CLINICAL NEUROLOGY
Neurology. Clinical practice Pub Date : 2024-06-01 Epub Date: 2024-04-18 DOI:10.1212/CPJ.0000000000200296
Justin G James, Lawrence R Wechsler, Christina A Blum, Charles J Bae, Thomas F Tropea
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引用次数: 0

Abstract

Background and objectives: Teleneurology usage has increased during the severe acute respiratory syndrome coronavirus 2 pandemic. However, studies evaluating physician impressions of inpatient teleneurology are limited. We implemented a quality improvement initiative to evaluate neurologists' impression following individual inpatient teleneurology consultation at a satellite hospital of a large academic center with no in-person neurology coverage.

Methods: A REDCap survey link was embedded within templates used by neurologists for documentation of inpatient consultations to be completed immediately after encounters. All teleneurology encounters with completed surveys at a single satellite hospital of the University of Pennsylvania Health System Neurology Department between May 10, 2021, and August 14, 2022, were included. Individual patient-level and encounter-level data were extracted from the medical record.

Results: A total of 374 surveys (response rate of 54.05%) were completed by 19 neurologists; 341 questionnaires were included in the analysis. Seven neurologists who specialized as neurohospitalists completed 231 surveys (67.74% of total surveys completed), while 12 non-neurohospitalists completed 110 (32.36%). The history obtained was rated as worse (14%) or the same (86%) as an in-person consult; none reported the history as better than nonteleneurology encounters. The physician-patient relationship was poor or fair in 25% of the encounters and good or excellent in 75% of visits. The overall experience was judged to be worse than in-person consultation in 32% of encounters, the same in 66%, and better in 2%. Fifty-one percent of providers responded that there were elements of the neurologic examination that might have changed their assessment and plan of care if performed in-person. Encounters with peripheral or neuromuscular-related chief complaints had the most inadequate examinations and worse overall experiences, while the most positive impressions of these clinical experiences were observed among seizure-related chief complaints.

Discussion: Determining best practices for inpatient teleneurology should consider the patient chief complaint to use teleneurology in scenarios with the highest likelihood of a positive experience. Further efforts should be made to the patient experience and to improve the remote examination to enhance the applicability of teleneurology to the full spectrum of inpatient neurologic consultations.

提供者对住院患者远程神经病学咨询的印象。
背景和目标:在严重急性呼吸系统综合征冠状病毒 2 大流行期间,远程神经病学的使用有所增加。然而,评估医生对住院患者远程神经病学印象的研究非常有限。我们在一家大型学术中心的卫星医院实施了一项质量改进计划,以评估神经科医生在进行个别住院患者远程神经科会诊后的印象:方法: 在神经科医生使用的住院会诊记录模板中嵌入 REDCap 调查链接,会诊结束后立即完成调查。在 2021 年 5 月 10 日至 2022 年 8 月 14 日期间,宾夕法尼亚大学卫生系统神经内科的一家卫星医院中所有完成调查的远程神经内科会诊均被纳入调查范围。从病历中提取了患者个人层面和会诊层面的数据:19名神经科医生共完成了374份调查问卷(回复率为54.05%),其中341份问卷被纳入分析。其中,7 名神经科医院专家完成了 231 份调查问卷(占总调查问卷的 67.74%),12 名非神经科医院专家完成了 110 份调查问卷(占总调查问卷的 32.36%)。获得的病史被评为比亲自会诊差(14%)或相同(86%);没有人报告病史比非神经科会诊好。25%的会诊中医患关系较差或一般,75%的会诊中医患关系良好或出色。在 32% 的就诊中,整体就诊体验被评为比当面问诊差,66% 的就诊体验与当面问诊相同,2% 的就诊体验比当面问诊好。51% 的医疗服务提供者回答说,如果亲自进行神经系统检查,有些内容可能会改变他们的评估和护理计划。与外周或神经肌肉相关的主诉的检查最不充分,总体体验也最差,而与癫痫发作相关的主诉对这些临床体验的印象最积极:讨论:在确定住院患者远程神经病学的最佳实践时,应考虑患者的主诉,以便在最有可能获得积极体验的情况下使用远程神经病学。应进一步努力改善患者体验和远程检查,以提高远程神经学在住院神经科会诊中的全面应用。
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来源期刊
Neurology. Clinical practice
Neurology. Clinical practice CLINICAL NEUROLOGY-
CiteScore
4.00
自引率
0.00%
发文量
77
期刊介绍: Neurology® Genetics is an online open access journal publishing peer-reviewed reports in the field of neurogenetics. The journal publishes original articles in all areas of neurogenetics including rare and common genetic variations, genotype-phenotype correlations, outlier phenotypes as a result of mutations in known disease genes, and genetic variations with a putative link to diseases. Articles include studies reporting on genetic disease risk, pharmacogenomics, and results of gene-based clinical trials (viral, ASO, etc.). Genetically engineered model systems are not a primary focus of Neurology® Genetics, but studies using model systems for treatment trials, including well-powered studies reporting negative results, are welcome.
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