Date of Award

January 2017

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Marc A. Auerbach

Abstract

Telemedicine can be used to provide specialty care to critically ill patients in rural and community hospital settings. However, the effects of this technology on quality of care are unclear. The objectives of this study were to evaluate the impact of a telepresent team leader on teamwork and communication, workload, and quality of care during a simulated pediatric resuscitation, and to explore provider perspectives on the use of telemedicine during resuscitations.

Twenty standardized teams (lead MD + bedside MD + two confederate clinical team members) were randomized to have a telepresent or an in-person leader. Telepresent leaders were connected via videoconference from a remote location and displayed on a screen at the bedside. All teams participated in a standardized, pre-programmed 20-minute simulated resuscitation with a scripted parent actor present. Simulations were video recorded and scored on teamwork and communication as well as clinical performance metrics using the validated STAT instrument. After each case, team members completed demographic, workload (NASA rTLX), and teamwork and communication (TeamMonitor) surveys. Post-simulation debriefings were scripted to collect qualitative data from participants regarding utility, effectiveness, and acceptability of telepresence.

There was no difference in STAT teamwork and communication scores (73 v 66; p=0.118), TeamMonitor scores (91 v 94; p=0.251), or teamwork and communication global rating scores (91 v 77; p=0.143). There was no difference in rTLX workload scores compared between team leaders (51 v 55; p=0.983) or between junior team members (44 v 59; p=0.123). Similarly, no difference was found in STAT clinical performance scores (72 v 64; p=0.168) or in time-to-defibrillation (238 sec v 253 sec; p=0.762).

Participating providers shared perspectives on the use of telepresence during resuscitation and expressed varying levels of comfort using the modality. Providers also highlighted strategies for the effective use of telepresence in the acute care setting, including enhanced verbal communication, role delineation, and mutual trust in clinical acumen of each provider involved.

Telepresence did not significantly impact teamwork and communication, workload, or clinical performance. Participating providers shared perspectives on the impacts of telepresence as well as strategies for effective use of telepresence in the acute care setting. Together, these data may inform future implementation of telepresence technology in emergency settings.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 06/12/2018

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