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    How to keep patients safe while offering telehealth

    Jens Hooiveld
    Last modified: 20 April 2021

    Telehealth is increasingly connecting patients with healthcare services such as regular checkups, minor acute-care episodes, the management of chronic conditions, and more, through various technologies. They include:

    • Video- and tele-conferencing
    • Remote monitoring
    • Electronic consultations

    Telehealth’s most basic terms define the physical location of participants. The “originating site” refers to the location of the patient, and the “distant site” refers to the location of the eligible healthcare provider. But no matter where the participants are located, patient safety and continuous improvement efforts for telehealth must be as stringent as they are for the care delivered in-clinic. If healthcare organizations can adapt their quality and risk management protocols to telehealth, there’s no doubt that it holds great promise for all.

    COVID-19 and telehealth’s boom

    For years, healthcare organizations were slow to adopt telehealth due to concerns over patient safety, patients’/providers’ comfort level with technology, and other factors. The Covid-19 pandemic changed things nearly overnight, and most healthcare providers now embrace the technology. Patients, too, appeared to be happy to access their providers at all during the pandemic, amid lockdowns and stay-at-home orders.

    Reimbursement for telehealth and virtual care by governments and private health insurers now appears to support the dramatic increase in adoption among healthcare providers.

    These developments bode well for patients and the clinicians who care for them. Still, patient safety must remain a priority.

    Making patient safety a priority while offering telehealth

    The burgeoning use of telehealth is transforming the tools providers use to monitor patients, as well. Platforms such as Glooko can transmit a patient’s blood glucose levels from their home and display in a dashboard that sits on a nurse’s desk. The goal is to alert the nurse if a patient’s readings fall into the danger zone, which would prompt a phone call to the patient or another clinical intervention.

    Incident reporting
    But what happens if the nurse misses an alert during a shift change, or because they’re focused on another patient? Whether it’s a relatively minor or a more serious adverse event, what’s important is making it easy for staff to document the incident—just as they would for an incident or event that occurs within the hospital’s walls.

    Safety culture
    Quality improvement and patient safety depend on the ability to collect data, analyze it, and implement improvements. Lack of transparency, communications breakdowns, and other hurdles exist whether care is delivered via telehealth or not. Following the spirit of Just Culture, Safety II, and other initiatives, organizations offering telehealth must learn from what goes well, and from system errors and events.

    Data security
    Because support is being provided via digital channels it's important to be aware of information security risks too. Secure the privacy of your patients and staff.

    Experts provide best practices with patient safety and telehealth

    Intense interest and investment in telehealth has attracted traditional health IT vendors and consumer technology companies. But the appropriate deployment of telehealth must prioritize patient safety, amid the rush to develop these technologies and get them in the hands of nurses, other healthcare providers, and patients.

    Stephen Agboola, MD, MPH and Joseph Kvedar, MD, two telehealth pioneers, wrote in Patient Safety Network, that “this is particularly true in the consumer-facing mHealth market, where apps and products may not have gone through formal safety or efficacy testing." Advice from Agboola and Kvedar to prioritize patient safety in the use of telehealth include the following tips:

    • Patient safety must remain the primary focus throughout a telehealth program’s lifecycle.
    • Data security and encryption protocols must be kept up to date when offering telehealth.
    • Regulatory and professional input, in addition to healthcare organizations’ own unique perspectives, will help to create consensus-driven guidelines, operational protocols, and standards. These efforts must be ongoing.
    • Disclosure of any possible risks must be made before patients are enrolled in the telehealth program.
    • Healthcare organizations should leverage platforms that allow clinicians to document their telehealth use and integrate those services into clinicians’ workflows.
    • Organizations must strive to remove barriers that exist due to low health literacy and other social or economic factors.

    Keep patients at the center of your telehealth implementation plans

    Patients/clients are the only ones to go through the entire care process. As a result, they can provide insight into any hidden imperfections in processes. Patient/client participation provides care institutions with essential information to further improve internal processes—and they can and should be given the opportunity to do the same for your telehealth program.

    When implementing patient participation, there are a few things to consider:

    1. Ensure your organization provides feedback once information (complaints, etc.) is received.
    2. Determine what is going to happen with the results.
    3. Formulate SMART goals for the improvement actions.
    4. Ensure that patients, caregivers, and management receive information about the results and the way forward.
    5. Ensure that the topic of patient/client participation remains on the agenda.
    6. Ensure a Plan–Do–Check–Act cycle or other method is in place for a cyclical and gradual improvement process.
    7. Regularly repeat the collection of data to provide a reliable picture and insight into changes.

    By using the same practical roadmap used for patient safety in-house, your healthcare organization can implement a safe, high-quality telehealth program.

    If you like to learn more about patient participation you can read our blogpost "Participation: How to give patients/clients a voice?". Or download our eBook about the impact of patient participation on quality of care.

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