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Neves AL, van Dael J, O’Brien N, et al. J Telemed Telecare. 2021;Epub Dec 12.
This survey of individuals living in the United Kingdom, Sweden, Italy, and Germany identified an increased use of virtual primary care services – such as telephone or video consultation, remote triage, and secure messaging systems – since the onset of the COVID-19 pandemic. Respondents reported that virtual technologies positively impacted multiple dimensions of care quality, including timeliness, safety, patient-centeredness, and equity.
Willis JS, Tyler C, Schiff GD, et al. Am J Med. 2021;134(9):1101-1103.
Telemedicine has become a more accepted care mode due to the COVID pandemic and general rural care access issues. This commentary suggests a 5-part framework for examining patient, physician, technological, clinical and health system influences on care management decisions that affect the safety of telediagnosis in primary care.
Cecil E, Bottle A, Majeed A, et al. Br J Gen Pract. 2021;71(708):e547-e554.
There has been an increased focus on patient safety, including missed diagnosis, in primary care in recent years. This cohort study evaluated the incidence of emergency hospital admission within 3 days of a visit with a GP with missed sepsis, ectopic pregnancy, urinary tract infection or pulmonary embolism. Shorter duration of appointment and telephone appointment (compared with in person) were associated with increased incidence of self-referred emergency hospital admission.

Graber ML, Schrandt S. Evanston, IL:  Society to Improve Diagnosis in Medicine;  September 8, 2021. 

This report summarizes the results of a project that examined how the literature and various stakeholders consider challenges and opportunities for improving diagnosis during telemedicine interactions. Both areas of concern and potential were highlighted to engage researchers, educators, and clinicians in the implementation and use of telediagnosis that is safe and of high-value for patients and families.
Pilosof NP, Barrett M, Oborn E, et al. Int J Environ Res Public Health. 2021;18(16):8391.
The COVID-19 pandemic has led to dramatic changes in healthcare delivery. Based on semi-structured interviews and direct observations, researchers evaluated the impact of a new model of remote inpatient care using telemedicine technologies in response to the pandemic. Intensive care and internal medicine units were divided into contaminated and clean zones and an integrated control room with audio-visual technologies allowed for remote supervision, communication, and support. The authors conclude that this model can increase flexibility in staffing via remote consultations and allow staff to supervise and monitor more patients without compromising patient and staff safety.

Ensuring maternal safety is a patient safety priority. This library reflects a curated selection of PSNet content focused on improving maternal safety. Included resources explore strategies with the potential to improve maternal care delivery and outcomes, such as high reliability, care standardization, teamwork, unit-based safety initiatives, and trigger tools.

Li L, Childs AW. J Psychiatr Pract. 2021;27(4):245-253.

Although telehealth has been available for some time, its use increased exponentially at the onset of the COVID-19 pandemic. Using the Six Domains of Health Care Quality (safe, timely, effective, efficient, equitable, patient-centered), the authors outline a framework to evaluate the safety and quality of psychiatric and behavioral health care provided via telehealth for older adults and disadvantaged youths.
Neprash HT, Sheridan B, Jena AB, et al. Health Aff (Millwood). 2021;40(8):1321-1327.
The COVID-19 pandemic led to an increase in the use of telehealth in order to limit patient exposure to the virus. Findings from this study highlight the value of telehealth visits for patients with suspected respiratory infections to prevent further transmission. Researchers found that patients exposed to influenza-like illness in primary care office settings were more likely than nonexposed patients to return with a similar illness within two weeks.

Washington, DC: Department of Veterans Affairs, Office of Inspector General. June 24, 2021. Report No. 19-09808-171.

This report examined veterans' health clinic use of telemental health to identify safety challenges inherent in this approach before the expansion of telemedine during the COVID-19 crisis. The authors note the complexities in managing emergent mental health situations in virtual consultations. Recommendations for improvement included emergency preparedness planning, specific reporting of telemental health incidents and organized access to experts.
Pathak S, Blanchard CM, Moreton E, et al. J Health Care Poor Underserved. 2021;32(2):737-750.
The growing use of telehealth can increase patient access to timely care, but also presents patient safety considerations. The use of telehealth to deliver health care services continues to expand. This systematic review included six studies examining safety and quality issues in community pharmacy-based telepharmacy services. Findings suggest that telepharmacies perform similarly or slightly better than traditional pharmacies in terms of medication safety and adherence, but the authors note a high risk of bias amongst the studies which limits the ability to draw definitive conclusions about patient safety and quality-related outcomes.

Patel J, Otto E, Taylor JS, et al. Dermatol Online J. 2021;27(3).

In an update to their 2010 article, this review’s authors summarized the patient safety literature in dermatology from 2009 to 2020. In addition to topics covered in the 2010 article, this article also includes diagnostic errors related to telemedicine, laser safety, scope of practice, and infections such as COVID-19. The authors recommend further studies, and reports are needed to reduce errors and improve patient safety.
Haveland S, Islam S. Telemed J E Health. 2021;Epub May 7.
At the start of the COVID-19 pandemic, many health systems and providers pivoted from in-person services to telehealth visits. Authors conducted a review of 21 studies evaluating the safety of telehealth visits. Three major themes emerged (telehealth experience, outcomes, and risks) along with several subthemes. Overall, the results suggest patients and clinicians have positive experiences and comparable health outcomes.
Simon GE, Stewart CC, Gary MC, et al. Jt Comm J Qual Patient Saf. 2021;47(7):452-457.
The COVID-19 pandemic expanded the use of telehealth and virtual care. This article describes one health system’s experience adapting suicide risk assessments for virtual visits and how the use of electronic health record patient portal messaging can facilitate systematic identification and assessment of suicide risk among patients receiving virtual mental health care.
Zhang T, Mosier J, Subbian V. JMIR Hum Factors. 2021;8(2):e24860.
The increased use of telehealth during the COVID-19 pandemic has not been without challenges. This article uses the Systems Engineering Initiative for Patient Safety (SEIPS) model to assess barriers related to telehealth implementation during the pandemic and the impact on patients, providers, technology, care processes, organizations, and the environment.

Evanston, IL: Society to Improve Diagnosis in Medicine; March 2021.

Telehealth is commonly used to deliver health care, yet its safety across the continuum has yet to be determined. This report highlights perspectives on the potential of telediagnosis and examines its reach, effectiveness, adoption, implementation, and maintenance, to inform actions to ensure its safe use.
Reeves JJ, Ayers JW, Longhurst CA. J Med Internet Res. 2021;23(2):e24785.
The COVID-19 pandemic has led to an extraordinary increase in the use of telehealth. This article discusses unintended consequences of telehealth and outlines guidance to assist health care providers in determining the appropriateness of a telehealth visit.
Chaudhry H, Nadeem S, Mundi R. Clin Orthop Relat Res. 2021;479(1):47-56.
The COVID-19 pandemic has dramatically increased the use of telehealth across various medical specialties.This systematic review did not identify any differences in patient or surgeon satisfaction or patient-reported outcomes with telehealth for orthopedic care delivery as compared to in-person visits.However, the authors note that the included studies did not adequately capture or report safety endpoints, such as complications or missed diagnoses.
Erkelens DC, Rutten FH, Wouters LT, et al. J Patient Saf. 2022;18(1):40-45.
Delays in diagnosis and treatment during after-hours care pose serious threats to patient safety. This case-control study compared missed acute coronary syndrome (ACS) cases to other cases with chest discomfort occurring during out-of-hours services in primary care. Predictors of missed ACS included the use of cardiovascular medication, non-retrosternal chest pain, and consultation of the supervising general practitioner.