Elucidation of the Needs for Telecritical Care Services in Japan: a Qualitative Study

Overview

Journal BMJ Open

Specialty General Medicine

Date 2023 Nov 20

PMID 37984942

Authors

Mizuki Morimoto

Nobutoshi Nawa

Eriko Okada

Yasuhiro Itsui

Ayako Kashimada

Kouhei Yamamoto

Yu Akaishi

Masanaga Yamawaki

Affiliations

Soon will be listed here.

Abstract

Objective: To clarify the reasons for consultation, advice sought by frontline physicians and relationship between the patient's pathology and the type of advice provided to guide the future development of telecritical care services.

Design: Secondary analysis of transcripts of telephone calls originally recorded for quality control purposes was conducted using a thematic content analysis. The calls were conducted between December 2019 and April 2021 (total cases: 70; total time: ~15 hour).

Settings: Intensivists provided consultation services to frontline physicians at secondary care institutions in the Kansai and Chubu regions.

Participants: Non-intensive care frontline physicians working in five secondary care institutions in the Kansai and Chubu regions and intensivists providing a consultation service (n=26).

Interventions: Not applicable.

Primary And Secondary Outcome Measures: The main outcome was the themes emerging from the language used during telephone and video consultations, indicating the gap filled by the telecritical care service.

Findings: We analysed 70 cases and approximately 15 hours of anonymised audio data. We identified the following reasons for consultation: 'lack of competence in treatment and diagnostic testing' and 'lack of access to consultation in their own hospital'. Frontline physicians most often sought advice related to 'treatment', followed by 'patient triage and transfer', 'diagnosis' and 'diagnostic testing and evaluation'. Regarding the relationship between the patient's pathology and type of advice provided, the most commonly sought advice by frontline physicians varied based on the patient's pathology.

Conclusion: This study explored the characteristics of 70 telecritical sessions and identified the reasons for and nature of the consultations. These findings can be used to guide the future provision and scale up of telecritical services.

References

Laudanski K, Scruth E, Winterbottom F, Rastrepo M, Dugar S, Herasevich V . A Survey of Tele-Critical Care State and Needs in 2019 and 2020 Conducted among the Members of the Society of Critical Care Medicine. Healthcare (Basel). 2022; 10(8). PMC: 9408319. DOI: 10.3390/healthcare10081445. View

Fortis S, Sarrazin M, Beck B, Panos R, Reisinger H . ICU Telemedicine Reduces Interhospital ICU Transfers in the Veterans Health Administration. Chest. 2018; 154(1):69-76. DOI: 10.1016/j.chest.2018.04.021. View

Deisz R, Rademacher S, Gilger K, Jegen R, Sauerzapfe B, Fitzner C . Additional Telemedicine Rounds as a Successful Performance-Improvement Strategy for Sepsis Management: Observational Multicenter Study. J Med Internet Res. 2019; 21(1):e11161. PMC: 6350091. DOI: 10.2196/11161. View

Armaignac D, Saxena A, Rubens M, Valle C, Williams L, Veledar E . Impact of Telemedicine on Mortality, Length of Stay, and Cost Among Patients in Progressive Care Units: Experience From a Large Healthcare System. Crit Care Med. 2018; 46(5):728-735. PMC: 5908255. DOI: 10.1097/CCM.0000000000002994. View

Yashiro D, Nawa N, Okada E, Kato H, Yonemori-Matsumoto S, Kashimada A . Facilitators and barriers to physicians' entrepreneurial ventures in major Japanese cities: A qualitative study. PLoS One. 2021; 16(10):e0258957. PMC: 8550390. DOI: 10.1371/journal.pone.0258957. View

Caruso D, Polici M, Zerunian M, Pucciarelli F, Guido G, Polidori T . Radiomics in Oncology, Part 1: Technical Principles and Gastrointestinal Application in CT and MRI. Cancers (Basel). 2021; 13(11). PMC: 8196591. DOI: 10.3390/cancers13112522. View

Lee J, Levy M . Treatment of Patients with Severe Sepsis and Septic Shock: Current Evidence-Based Practices. R I Med J (2013). 2019; 102(10):18-21. View

Fusaro M, Becker C, Scurlock C . Evaluating Tele-ICU Implementation Based on Observed and Predicted ICU Mortality: A Systematic Review and Meta-Analysis. Crit Care Med. 2019; 47(4):501-507. DOI: 10.1097/CCM.0000000000003627. View

Young L, Chan P, Cram P . Staff acceptance of tele-ICU coverage: a systematic review. Chest. 2010; 139(2):279-288. PMC: 3032369. DOI: 10.1378/chest.10-1795. View

10.

Rosenfeld B, Dorman T, Breslow M, Pronovost P, Jenckes M, Zhang N . Intensive care unit telemedicine: alternate paradigm for providing continuous intensivist care. Crit Care Med. 2001; 28(12):3925-31. DOI: 10.1097/00003246-200012000-00034. View

11.

Wongsurakiat P, Chitwarakorn N . Severe community-acquired pneumonia in general medical wards: outcomes and impact of initial antibiotic selection. BMC Pulm Med. 2019; 19(1):179. PMC: 6794881. DOI: 10.1186/s12890-019-0944-1. View

12.

Nair G, Niederman M . Updates on community acquired pneumonia management in the ICU. Pharmacol Ther. 2020; 217:107663. PMC: 7428725. DOI: 10.1016/j.pharmthera.2020.107663. View

13.

Kemp Van Ee S, McKelvey H, Williams T, Shao B, Lin W, Luu J . Telemedicine Intensive Care Unit (Tele-ICU) Implementation During COVID-19: A Scoping Review. Cureus. 2022; 14(5):e25133. PMC: 9206410. DOI: 10.7759/cureus.25133. View

14.

McSweeney S, ODonoghue P, Jhaveri K . Current and emerging techniques in gastrointestinal imaging. J Postgrad Med. 2010; 56(2):109-16. DOI: 10.4103/0022-3859.65280. View

15.

Becker C, Fusaro M, Al Aseri Z, Millerman K, Scurlock C . Effects of Telemedicine ICU Intervention on Care Standardization and Patient Outcomes: An Observational Study. Crit Care Explor. 2020; 2(7):e0165. PMC: 7365711. DOI: 10.1097/CCE.0000000000000165. View

16.

Udeh C, Udeh B, Rahman N, Canfield C, Campbell J, Hata J . Telemedicine/Virtual ICU: Where Are We and Where Are We Going?. Methodist Debakey Cardiovasc J. 2018; 14(2):126-133. PMC: 6027727. DOI: 10.14797/mdcj-14-2-126. View

17.

Khunlertkit A, Carayon P . Contributions of tele-intensive care unit (Tele-ICU) technology to quality of care and patient safety. J Crit Care. 2012; 28(3):315.e1-12. DOI: 10.1016/j.jcrc.2012.10.005. View

18.

OBrien B, Harris I, Beckman T, Reed D, Cook D . Standards for reporting qualitative research: a synthesis of recommendations. Acad Med. 2014; 89(9):1245-51. DOI: 10.1097/ACM.0000000000000388. View