Impact of telemedicine in hospital culture and its consequences on quality of care and safety

ABSTRACT Objective To describe the impact of the telemedicine application on the clinical process of care and its different effects on hospital culture and healthcare practice. Methods The concept of telemedicine through real time audio-visual coverage was implemented at two different hospitals in São Paulo: a secondary and public hospital, Hospital Municipal Dr. Moysés Deutsch, and a tertiary and private hospital, Hospital Israelita Albert Einstein. Results Data were obtained from 257 teleconsultations records over a 12-month period and were compared to a similar period before telemedicine implementation. For 18 patients (7.1%) telemedicine consultation influenced in diagnosis conclusion, and for 239 patients (92.9%), the consultation contributed to clinical management. After telemedicine implementation, stroke thrombolysis protocol was applied in 11% of ischemic stroke patients. Telemedicine approach reduced the need to transfer the patient to another hospital in 25.9% regarding neurological evaluation. Sepsis protocol were adopted and lead to a 30.4% reduction mortality regarding severe sepsis. Conclusion The application is associated with differences in the use of health services: emergency transfers, mortality, implementation of protocols and patient management decisions, especially regarding thrombolysis. These results highlight the role of telemedicine as a vector for transformation of hospital culture impacting on the safety and quality of care.

摘要
目的 阐明远程医疗应用对临床诊疗流程的影响，及其对医院文化与医疗实践产生的多维度作用。
方法 本研究在圣保罗州的两家不同医院落地实时音视频远程医疗模式：其一为二级公立医疗机构——莫伊塞斯·德乌什博士市立医院（Hospital Municipal Dr. Moysés Deutsch），其二为三级私立医疗机构——以色列阿尔伯特·爱因斯坦医院（Hospital Israelita Albert Einstein）。
结果 研究收集了12个月内的257条远程会诊记录，并与远程医疗实施前的同期数据开展对照分析。结果显示，18例患者（占比7.1%）的最终诊断结论受远程会诊影响，239例患者（占比92.9%）的临床诊疗方案得益于远程会诊支持。远程医疗实施后，缺血性脑卒中患者中有11%应用了卒中溶栓诊疗方案。针对神经科评估场景，远程医疗模式使患者转诊至其他医院的需求降低了25.9%。脓毒症标准化诊疗方案的落地实施，使重症脓毒症患者的死亡率降低了30.4%。
结论 该远程医疗应用与医疗服务使用模式的改变密切相关，具体涉及急诊转诊率、患者死亡率、诊疗方案落地及患者管理决策等维度，尤以溶栓治疗领域的改善最为显著。本研究结果凸显了远程医疗作为医院文化变革载体的核心价值，其可有效提升医疗照护的安全性与服务质量。