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At least 1,099 records · Page 61Linked to original sources
PubMed2001

Communication skills for telehealth interactions.

Telehealth technologies provide a challenging new home care approach. Through the use of cameras, video display services, and telephone lines, nurses can interact with patients located several miles away. In delivering services from a distance, the ease of equipment operation and installation, picture, and voice quality are important. Of equal importance are the nurse's communication skills in conducting telehome visits.

Communication↗
PubMedDate not supplied

Computerized telephone nurse triage. An evaluation of service quality and cost.

The current reimbursement structure of health care in the United States motivates the providers of health care services to deliver these services with a cost-conscious mentality without compromising quality. This has led to the development of alternative methods of delivering health care services, one of which is computerized telephone nurse triage. This study investigates service quality from the perception of callers who used this system on behalf of a pediatric client. Cost was evaluated by comparing what the caller would have done if they did not speak with nurse triage with what they actually did after their interaction. A modified version of the SERVQUAL tool was administered via telephone survey to members of a managed health care plan who recently used nurse triage services for a pediatric patient. Findings were that the majority of callers--employed female parents--rated the level of service quality very highly. Education, employment status, age of the caller, child gender, birth order among siblings, and age of child did not affect the rating of service quality. Relationship to the child had an effect on the rating of service quality as men/fathers rated the level of service quality slightly lower than their female/mother counterparts. The evaluation of cost revealed that the action taken by the caller after they spoke with the nurse resulted in significant cost savings. Computerized telephone nurse triage is a well-accepted cost-saving alternative method of health care delivery that can effectively serve a variety of callers and pediatric patients.

Adult↗
PubMed2000

Tel-eNurse Practice: a practice model for role expansion.

RNs are expanding their role in the continuum of care, incorporating telecommunication into their practice to provide efficient and effective patient care. However, role expansion requires the definition and articulation of nursing practice and related outcomes. The Tel-eNurse Practice Model is a theoretical framework nurses can use to define and guide the complex process of care in the telephone encounter. Application of the model gives nurse administrators a way to identify competencies and develop standards of practice and quality and outcomes measurement tools.

Decision Making↗
PubMed2001

Tel-eNurse Practice. Quality of care and patient outcomes.

As a growing specialty, telephone nursing practice requires definition, standardization, and identification of quality indicators and nursing-sensitive outcomes. An informal study was conducted to explore the relationship between telephone nursing quality indicators-assessment, critical thinking, use of protocols, and continuity of care-found in documentation and nursing-sensitive patient outcomes. Findings provide insight into the telephone process of care and application of critical thinking reflected in documentation and greater understanding of the complexity of telephone nursing practice and integration of care and outcomes.

Documentation↗
PubMed2002

Tel-eNursing practice: setting standards for practice across the continuum of care.

What was thought to be a quick and limited quality performance improvement (QPI) project between a few departments providing telephone nursing services became an involved organization-wide QPI project to standardize telephone practice. Initially, telephone nursing practice, expanded roles of nurses, and extent of healthcare professionals using the telephone to provide care from afar were not well understood. Lack of standardization and quality and risk management issues were identified. The Good Samaritan Community Healthcare QPI plan of action provided the roadmap to standardize telephone practice across the organization. Many leadership challenges occurred along the road to QPI for telephone practice, as caution signs were acknowledged, hills were climbed, and corners maneuvered.

Humans↗
PubMed1999

Overview of telemedicine applications for otolaryngology.

OBJECTIVE/HYPOTHESIS: As we evolve into the managed care era, telemedicine technologies can help to provide efficiencies for the entire health care system. Our practice is centered around a residency training program in a federal facility. Our goal was to lay the groundwork for an entire service being on-line. STUDY DESIGN: Prospective. METHODS: The stepwise process is as follows: needs assessment to examine what part of the practice would lend itself to telemedicine deployment; usability studies to select the best equipment; study in-house to normalize the technology to the current standard of care comparing control subjects with experimental subjects; and deploying remote units to study remote referral. RESULTS: Video-otoscopy captures the image of an eardrum that can be sent from a remote site in a store-forward mode. After normalizing the standard of care, the potential for diagnosing and treating certain ear conditions such as hearing loss is readily apparent. An audiogram, pertinent laboratory data, and history and physical performed by the referring primary care provider would allow the patient to be seen and triaged virtually. Time savings for the patient and the otolaryngologist would be gained. Initial data indicate a greater than 90% correlation with handheld otoscopy and binocular microscopy. In speech sciences, a need existed to evaluate and treat patients from remote sites where speech therapists are unavailable. The use of live video teleconferencing to evaluate and treat patients in-house has preliminary results that show no difference in outcomes. Studying the proctoring of remote surgeons is also a need, as one of our military missions. Initial data show no difference in outcomes when residents are proctored by attending physicians from a physically separated control room in the hospital. We also participate with the Internet Tumor Board, which links four remote sites with our medical center. Different sites scroll through the slides that are listed on a Web site while linking each site with audio teleconferencing. We are initiating Internet Grand Rounds using the same technology. CONCLUSION: These efforts performed in a stepwise approach will lead to an otolaryngology--head and neck surgery service that is on-line for the next millennium, with telemedicine advances normalized to the standard of care.

Hawaii↗
PubMed1999

The effectiveness of videophones in home healthcare for the elderly.

OBJECTIVES: This study evaluates the effectiveness of telecare, the use of videophones in healthcare for the elderly in communities, and proposes an effective application of telecare in home healthcare. METHODS: An intervention study design was applied to evaluate the add-on benefits to home healthcare from a videophone system using Integrated Services Digital Network (ISDN) installed in individual homes of clients and service providers. An intervention group of home healthcare cases were provided with videophones (VHHC group), and it was compared to a reference group of regular healthcare cases (HHC group). Persons from the 2 groups were individually matched according to sex, age, and their independence in activities of daily living. The functional independence of the individuals in the 2 groups was assessed before and 3 months after home healthcare was started, with and without videophones. The effectiveness of videophones was assessed by analyzing the improvements in functional independence using a paired t test. RESULTS: Improvements in functional independence of 5 pairs of males and 11 pairs of females were analyzed. Improvements in ADL, communication, and social cognition independence of the VHHC group over the 3-month trial period measured by the Functional Independence Measure were 1.5 points, 0.7 points, and 1.9 points, respectively; statistically, these were significantly greater than those of the HHC group (individually P < 0.05). CONCLUSIONS: The effectiveness of the videophones in home healthcare service was found to be significant. This evidence supports the use of videophones in home healthcare to improve the quality of service.

Activities of Daily Living↗
PubMed2000

The effect of automated calls with telephone nurse follow-up on patient-centered outcomes of diabetes care: a randomized, controlled trial.

OBJECTIVE: We evaluated the impact of automated telephone disease management (ATDM) calls with telephone nurse follow-up as a strategy for improving outcomes such as mental health, self-efficacy, satisfaction with care, and health-related quality of life (HRQL) among low-income patients with diabetes mellitus. RESEARCH DESIGN: This was a randomized, controlled trial. SUBJECTS: Two hundred forty-eight primarily English- and Spanish-speaking adults with diabetes enrolled at the time of visits to a county health care system. INTERVENTION: In addition to usual care, intervention patients received biweekly ATDM calls with telephone follow-up by a diabetes nurse educator. Patients used the ATDM calls to report information about their health and self-care and to access self-care education. The nurse used patients' ATDM reports to allocate her time according to their needs. MEASURES: Patient-centered outcomes were measured at 12 months via telephone interview. RESULTS: Compared with patients receiving usual care, intervention patients at follow-up reported fewer symptoms of depression (P = 0.023), greater self-efficacy to conduct self-care activities (P = 0.006), and fewer days in bed because of illness (P = 0.026). Among English-speaking patients, those receiving the intervention reported greater satisfaction with their health care overall and with the technical quality of the services they received, their choice of providers and continuity of care, their communication with providers, and the quality of their health outcomes (all P <0.042). Intervention and control patients had roughly equivalent scores for established measures of anxiety, diabetes-specific HRQL, and general HRQL. CONCLUSIONS: This intervention had several positive effects on patient-centered outcomes of care but no measurable effects on anxiety or HRQL.

Adaptation, Psychological↗
PubMed1996

Neurosurgery and the Internet: a critical analysis and a review of available resources.

Thanks to the development of computers and telecommunication, the concept of communication is undergoing radical changes. Scientific collaboration among medical professionals has evolved rapidly in the last few years toward the use of Internet, a new tool which will change the world of health. It is impossible to predict at present where this new type of scientific collaboration will lead us, but what is certain is that in the next decade, the so-called electronic communities will be created and will develop at an extraordinary rate. The increase in the capacity of image processing in computers and in the rate of transmission of data over the net will make possible applications such as the remote medical visit, video conferences, surgical simulation or even remote virtual surgery. However, while some medical professionals are dreaming of this type of electronic communication in the future, others are using it right now, taking advantage of all of its benefits. In fact, electronic communities are already a reality, being accessible today, and not a future goal. Being inside or outside these communities will make the difference between health professionals. It is well worth therefore being in contact with these new fields so as not to miss the boat of technological development. We present a comprehensive listing of neurosurgical resources available on the Internet, and some ideas on the present and future applications of the Internet in the world of Health Care.

Computer Communication Networks↗
PubMed1998

Report of a national neurosurgical emergency teleconsulting system.

OBJECTIVE: The goal was to develop a low-cost, national, neurosurgical emergency teleconsulting system that is independent of vendor computed tomographic (CT) or magnetic resonance imaging (MRI) scanner type. METHODS: Charge-coupled device scanners are used to digitize hard copies of CT and MRI scans. An enhanced optical density range is achieved by using an algorithm to fuse data from multiple exposures at different integration periods. The system is based on personal computers using Microsoft Windows 3.11. Data are transmitted on a wide-area network at 128 kilobits/s, over Integrated Systems Digital Network lines. The network connects both neurosurgical departments in Ireland to all major hospitals with CT/MRI scanners. RESULTS: The scanner optical density is 0.05 to 3.0, with 2.24 to 2.5 line pairs/mm. Five-megabyte images are transmitted uncompressed in 6 minutes. To date, more than 750 CT and MRI scans have been transmitted. The system is completely automated, and operator acceptance has been very high. Images are automatically stored and displayed at the receiving workstation, where the images can be viewed and manipulated on-screen. This system has significantly enhanced acute neurosurgical patient care. CONCLUSION: The system is cost effective and simple to use, has gained widespread physician acceptance, and delivers an image quality superior to that of many commercially available systems.

Angiography↗
PubMed2000

18FDG SPECT to assess myocardial viability: initial experience at a hospital remote from a cyclotron.

18F-Fluorodeoxyglucose positron emission tomography (18FDG PET) is the recognized gold standard for the assessment of myocardial viability, but is not widely available in the UK. FDG imaging on a gamma camera with high-energy collimators (FDG SPECT) has been shown to have an accuracy comparable with that of FDG PET for the assessment of myocardial viability. This study was performed to assess the feasibility of introducing FDG SPECT for myocardial viability at a hospital a considerable distance away from a cyclotron (200 miles). Twenty-three patients, who were being actively considered for revascularization but had demonstrated fixed defects on stress/rest with nitrate tetrofosmin imaging, underwent FDG SPECT. Image quality was acceptable in all patients. Nine out of the 23 patients with defects classed as fixed on tetrofosmin imaging demonstrated viability on FDG SPECT. Six of these nine patients, reported to have some viable myocardium on FDG SPECT, underwent revascularization as a result. This study has demonstrated that FDG SPECT is feasible at a site some distance from a cyclotron.

Adult↗
PubMed1997

Remote monitoring. Expanding a successful system.

A successful telemetry placement system moves into five medical/surgical areas and two step-down units. The updated equipment included an alarm gateway with an arrhythmia detection system. Telemetry signals are transmitted to a pager worn by nurses; remote display monitors allow nurses to eyeball arrhythmias and reset their alarm without going to a central station.

Equipment Failure↗