Search results for "United States of America"

Telemedicine is being more widely used in order to increase access to care. A relatively new aspect of telemedicine is direct-to-consumer telemedicine, including teledermatology. Using secret shoppers who submitted photographs and clinical information to teledermatology sites, this study found poor diagnostic accuracy and failure to elicit important information. Other studies have also raised concerns about the diagnostic accuracy of virtual clinical visits.

There seems to be an increasing patient demand for immediately accessible virtual medical visits via the Internet. Although provision of this service has proliferated, little is known about the quality of care delivered by these models. This audit study used trained standardized patients—"secret shoppers"— to present common acute illnesses to the eight most popular commercial virtual visit websites. Physicians correctly named diagnoses in 77% of the visits, but key management decisions complied with guidelines in only about half of cases. The quality of care provided varied widely across websites. Virtual visit physicians frequently prescribed antibiotics inappropriately, though this is also true in traditional clinic settings. Conversely, physicians generally did not order additional testing, even when it would be recommended by guidelines, such as in ankle pain cases with specific concerning signs. These findings call for further study to understand these emerging models of care delivery and specific opportunities to improve quality and safety in these settings.

The frequency of missed and delayed diagnoses is stimulating interest in innovative ways of improving the diagnostic process. This study reports on the initial experience of a crowdsourcing approach to diagnosis. Patients with difficult-to-diagnose symptoms accessed an online program where volunteer case solvers—only 58% of whom worked in medicine in any capacity—engaged in discussion with patients and provided diagnostic suggestions. A majority of patients felt the service was useful and about half would recommend the program.

This narrative review of safety in telephone triage found that the lowest error rates occurred in systems where clinicians performed triage within a robust system that facilitated information exchange (such as an electronic medical record with triage decision support).

Following health care reforms, hospitals may now receive lower Medicare reimbursements based on 30-day readmission rates. This commentary describes several successful programs aimed at reducing readmissions and reviews pharmacy engagement in these efforts, including tactics such as improved medication reconciliation and patient counseling.

Providing patients with an accurate list of their medication at discharge can be challenging. This commentary reveals the development, implementation, and initial testing of a service managed by pharmacists that engaged telepharmacy support as partners to enhance medication reconciliation at discharge. By the end of the 19-month pilot program, the service enhanced the quality of final medication lists and documentation given to patients at discharge.

This article describes an intervention that trained health coaches to use mobile technology to assess the health status of recently discharged Medicare patients, first during an in-home visit 48 hours after leaving the hospital and then with weekly phone calls over a 3-week period. The program resulted in decreased readmission rates and significant cost savings.

According to this study, the North Dakota Telepharmacy Project frequently identifies and resolves medication issues at 17 critical access hospitals. Telepharmacies are increasingly proving to be effective at providing medication safety for rural hospitals.

Children are at high risk for medication errors in emergency departments (EDs). Physician prescribing has been implicated as the most common source of these errors. This retrospective study found that telemedicine consultations for pediatric critical care were associated with fewer physician-related medication errors among seriously ill children in rural EDs. Telemedicine consultations seemed to reduce medication errors more than traditional telephone consultations. Telemedicine may prove to be an important tool for improving the care of rural patients across many different scenarios.

The SBAR (situation, background, assessment, recommendation) communication tool has been implemented in an effort to improve nurse–physician communication, particularly by telephone. For this simulation study, 20 nurse–physician pairs were enrolled and the nurse in each pair was randomized to receive six written clinical scenarios to convey to the physician (three using the SBAR format, three in the usual format). Investigators found that relevant information was often not communicated by the nurse nor elicited by physicians, and use of SBAR did not improve communication.

For this qualitative study, researchers interviewed staff of remotely monitored intensive care units (tele-ICUs) and found many ways in which tele-ICUs improve safety and quality, primarily through anticipating and preventing complications.

Medication error rates at community pharmacies (with pharmacists on-site) were similar to rates at remote telepharmacies (which are staffed by pharmacy technicians with remote pharmacist oversight). However, remote telepharmacies reported more near misses.

This demonstration study suggests that after-hours telepharmacy review may provide an effective strategy for reducing medication errors at rural hospitals.

This magazine article reports on cases in which outsourcing the interpretation of radiology tests contributed to patient harm.

This study reported a lower overall medication error rate for telepharmacy sites compared with traditional pharmacies.

General surgery residents strongly preferred signing out patients in person rather than by videoconferencing or other electronic modalities, but in this simulation study, signout accuracy was suboptimal in all methods tested.

This newspaper article describes government-funded and hospital-based efforts to improve discharge and reduce preventable readmissions.

This collection provides information on programs and tools to improve medication safety.

Implementation of telemedicine (remote monitoring of patient care by intensivists) was associated with improved safety culture among intensive care unit nurses.

Telehealth is a rapidly expanding approach of adopting technology to deliver health care services and information that improves the quality, safety, access, efficiency, and costs of care. Although the evidence that telehealth achieves these aims is still lacking, this report outlines AHRQ's health information technology portfolio, which funded a number of programs to evaluate this promising technology and approach. The report findings are based on interviews with lead investigators. It discusses the scope of the projects funded, the technical challenges faced, the organizational and cultural issues encountered, and the opportunities ahead.