Abstract
Introduction Timely healthcare is at core of patient safety. However, it is challenged by low hospital workforce capacity coinciding with an increasing demand for healthcare utilization. Re-organization of healthcare services including home-based programs (eg. Hospital-at-Home, Virtual Wards) are proposed as a solution.1 Remote monitoring via telemedicine is proposed to save travel time for both patients and hospital staff and smart alerts can support timely management. The stakeholder attitude towards virtual healthcare and their utilization of telemedicine is essential to assess as it is the key to successful outcomes for patients.
Influenz-er is a telemedicine-supported early discharge program proposed as an acceptable and safe alternative to a standard hospitalization of patients at the Department of Pulmonary and Infectious Diseases (DPID) at the North Zealand University Hospital, Denmark. Patients enrolled in the program are transferred from hospital to their home to be monitored remotely by hospital staff. A telemedicine platform facilitates health data transfer and alert hospital staff in case of sign of clinical deterioration to support timely management. Thus, the program aims to provide hospital-level safety and quality for patients in their homes.
Methods We are currently investigating the feasibility of program Influenz-er in terms of patient safety, patient and hospital staff acceptance, and implementation at hospital-department level prior to a full-scale effectiveness trial. One of the research questions is whether Influenz-er program is perceived as acceptable, appropriate, and feasible by hospital staff and whether hospital staff can provide timely care for patients who are monitored remotely from home. Both qualitative and quantitative data were collected.
We applied RE-AIM framework2 3 as recommended by the World Health Organization4 to perform a process evaluation of Influenz-er program as a part of a feasibility study with 19 patients. We focused on the RE-AIM dimensions adoption and implementation. We collected data on the proportion of the DPID staff trained within the Influenz-er program. Short staff survey was performed to assess the initial level of acceptance, perceived appropriateness, and feasibility of the program. The implementation fidelity is currently assessed via analysis of quantitative process data from the telemedicine platform (eg., time to registered action upon an incoming alert) together with qualitative field data collected during observations of how DPID staff delivered the program. Also, data on incidence of adverse events were collected.
Results Preliminary results show high level of initial adoption and acceptance among DPID staff and no severe adverse events for patients (n=19) enrolled to the program. Interestingly, the quantitative process data imply somewhat low fidelity to timely registration of clinical actions, however the observations of DPID staff reveal safe clinical actions according to the protocol. Thus, the low fidelity numbers probably mirror a bad choice of the quantitative fidelity measure and a current challenge with low workforce capacity and therefore low prioritization of non-clinical administrative tasks such as timely registration on the telemedicine platform for research purposes.
References
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World Health Organization, 2016. Monitoring and evaluating digital health interventions: a practical guide to conducting research and assessment. Accessed on 28’th of May 2023 at https://www.who.int/publications/i/item/9789241511766
