Mobile videoconferencing for enhanced emergency medical communication - a shot in the dark or a walk in the park? ‐‐ A simulation study

Background: Videoconferencing on mobile phones may enhance communication, but knowledge on its quality in various situations is needed before it can be used in medical emergencies. Mobile phones automatically activate loudspeaker functionality during videoconferencing, making calls particularly vulnerable to background noise. The aim of this study was to investigate if videoconferencing can be used between lay bystanders and Emergency Medical Dispatch (EMD) operators for initial emergency calls during medical emergencies, under suboptimal sound and light conditions. Methods: Videoconferencing was tested between 90 volunteers and an emergency medical dispatcher in a standardized scenario of a medical emergency. Three different environments were used for the trials: indoors with moderate background noise, outdoors with daylight and much background noise, and outdoors during nighttime with little background noise. Thirty participants were recruited for each of the three locations. After informed consent, each participant was asked to use a video mobile phone to communicate with an EMD operator. During the video call the EMD operator gave instructions for tasks to be performed by the participant. The video quality from the caller to the EMD was evaluated by the EMD operator and rated on a five step scale ranging from “not able to see” to “good video quality”. Sound quality between participants and EMD operators was assessed by a method developed for this trial. Kruskal – Wallis and Chi-square tests were used for statistical analysis. Results: Video quality was significantly different between the groups (p <0.001), and the nighttime group had lower video quality. For most sessions in the nighttime group it was still possible to see actions done at the simulated emergency site. All participants were able to perform their tasks according to the instructions given by dispatchers, although with a need for more repetitions during sessions with much background noise. No calls were rated by dispatchers as incomprehensible due to low sound quality and only 3% of the calls were considered somewhat difficult or very difficult to understand. Conclusions: Videoconferencing on mobile phones can be used for the initial emergency call during medical emergencies also in suboptimal conditions

VIDEOCARE: Decentralised psychiatric emergency care through videoconferencing

BACKGROUND: Today the availability of specialists is limited for psychiatric patients in rural areas, especially during psychiatric emergencies. To overcome this challenge, the University Hospital of North Norway has implemented a new decentralised on-call system in psychiatric emergencies, by which psychiatrists are accessible by videoconference 24/7. In September 2011, the new on-call system was established in clinical practice for patients and health staff at three regional psychiatric centres in Northern Norway. Although a wide variety of therapies have been successfully delivered by videoconference, there is limited research on the use of videoconferenced consultations with patients in psychiatric emergencies. The aim of this study is to explore the use of videoconference in psychiatric emergencies based on the implementation of this first Norwegian tele-psychiatric service in emergency care. METHODS/DESIGN: The research project is an exploratory case study of a new videoconference service in operation. By applying in-depth interviews with patients, specialists and local health-care staff, we will identify factors that facilitate and hinder use of videoconferencing in psychiatric emergencies, and explore how videoconferenced consultations matter for patients, professional practice and cooperation between levels in psychiatric care. By using an on-going project as the site of research, the case is especially well-suited for generating reliable and valid empirical data. DISCUSSION: Results from the study will be of importance for understanding of how videoconferencing may support proper treatment and high-quality health care services in rural areas for patients in psychiatric emergencies

Methodology for Health Care Process Modelling: Bringing the Health Care Complexity into Health IT System Development

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The workload of web-based consultations with atopic eczema patients at home

Abstract Background Atopic eczema is a chronic inflammatory non-contagious skin disease characterised by intensive itch and inflamed skin. Due to its chronic and relapsing course atopic eczema imposes a great burden on affected families. Review articles about home care telemedicine have indicated advantageous effects of home telehealth. However, few studies have investigated how home care telemedicine applications affect the workload of the clinician. Methods The use of a web-based counselling system was recorded through computerised logging. The doctor who answered the requests sent via the Internet recorded the amount of time needed for reading and answering 93 consecutive requests. Results The time needed by the physician to read and answer a request was less than 5 minutes in 60% of the cases. The doctor spent significantly more time to answer requests that had photographs attached compared to requests without photographs (P = 0.005). The time needed to answer requests received during the winter season (October-March) was significantly longer than the rest of the year (P = 0.023). There was no correlation between the answering time and the age of the patient. Conclusions Individual web-based follow-up of atopic eczema patients at home is feasible. The amount of time needed for the doctor to respond to a request from the patient appears to be small. The answering time seems to depend on whether photographs are supplied and also on seasonal variations of disease activity. Since the management of atopic eczema is complex involving many different types of treatments and educational aspects, we expect this type of communication to be useful also to other chronic disease patients requiring close follow-up.</p

Supporting lay bystanders during out-of-hospital cardiac arrest : comparison of video calls and audio calls for instructions and supervision

Akuttmedisinske situasjoner krever rask, god og effektiv kommunikasjon. Publikum har i økende grad mulighet for videokonferanse via vanlige mobiltelefoner. Kan legfolk i fremtiden få bedre hjelp fra medisinsk nødnummer (113) hvis de kan vise levende bilder fra akuttmedisinske situasjoner via mobiltelefonen? Dette er hovedspørsmålet i dette doktorgradsarbeidet utført ved Nasjonalt senter for samhandling og telemedisin og Akuttmedisinsk klinikk ved Universitetssykehuset Nord-Norge. 180 elever fra videregående skoler i Tromsø deltok som legfolk ved simulerte hjertestans. Under forsøkene kommuniserte elevene med AMK-sykepleiere på medisinsk nødnummer (113). Kommunikasjonen skjedde ved hjelp av to typer mobiltelefoner: vanlige mobiler med kun tale, eller mobiler med både tale og toveis bildeoverføring (video). Tidsbruk og kvaliteten på gjennomført gjenoppliving ble målt på gjenopplivingsdukker i en randomisert kontrollert studie. Sykepleierne ble intervjuet og studentene besvarte et spørreskjema etter forsøkene. Et panel sammensatt av ulike fagprofesjoner utførte risikoanalyse av informasjonssikkerheten for videokonferanse via mobiltelefoner mellom legfolk og medisinsk nødnummer (113). Ifølge sykepleierne som deltok i forsøkene ga videokonferanse økt kvalitet på kommunikasjonen med legfolk, og enklere veiledning når de kunne se både «pasienten» og gjenopplivingsforsøkene. Sykepleierne mente derfor videokonferanse kan gi økt trygghet, spart tid og bedre behandling. Kvaliteten på videokonferansen var for dårlig i disse forsøkene til å gi tydelige forskjeller i gjennopplivingskvaliteten, men legfolk følte det tryggere å ha visuell kontakt med AMK-operatørene. Risikoanalyse av denne teknologien avdekket ikke uakseptable risiki mot informasjonssikkerheten. Nye mobiltelefoner med videotelefoni og bedre teknologi vil kunne gi bedre kvalitet på nødkommunikasjonen og gjenopplivning i akuttsitusjoner. Reelle hendelser må studeres for å finne hvordan billedkommunikasjon best kan utnyttes i akuttmedisinske situasjoner

Video-confidence: a qualitative exploration of videoconferencing for psychiatric emergencies

Background: In psychiatric emergencies in rural areas the availability of psychiatrists are limited. Therefore, tele-psychiatry, via real-time videoconferencing (VC), has been developed to provide advanced consultative services to areas that lack psychiatrists. However, there is limited research on the use of VC for psychiatric emergencies. The University Hospital of North Norway has been the first hospital in Norway to implement this type of service by developing a new on-call system for psychiatric emergency practice through which psychiatrists are accessible by telephone and VC 24 hours a day for consultations with patients and nurses at three regional psychiatric centres. This study explores patients’, psychiatrists’ and nurses’ experiences of using VC for psychiatric emergencies, as well as how the technology influenced their confidence. Methods: In this study, we used a qualitative explorative research design. With a particular focus on users’ experiences of VC, we conducted 29 semi-structured interviews with patients, psychiatrists and nurses who had participated in a VC consultation in at least one psychiatric emergency. Results: Our findings show that access to the VC system increased the experience of confidence in challenging psychiatric emergencies in four ways: (1) by strengthening patient involvement during the psychiatric specialist’s assessment, (2) by reducing uncertainty, (3) by sharing responsibility for decisions and (4) by functioning as a safety net even when VC was not used. Conclusions: This study has demonstrated that an emergency psychiatric service delivered by VC may improve the confidence of psychiatrists, nurses and patients in challenging psychiatric emergencies. VC can serve as an effective tool for ensuring decentralised high-quality psychiatric services for emergency care. Keywords: Psychiatry, Emergency care, Videoconferencing, Tele-psychiatry, Confidence, Qualitative study