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1/n
Thread for healthcare providers on video consultations (VCs) as a partial solution to #COVID pandemic. Iâll cover RESEARCH, CLINICAL, TECHNICAL, STRATEGIC and OPERATIONAL issues.
Mute this thread if not interested â itâs quite long.
Thread for healthcare providers on video consultations (VCs) as a partial solution to #COVID pandemic. Iâll cover RESEARCH, CLINICAL, TECHNICAL, STRATEGIC and OPERATIONAL issues.
Mute this thread if not interested â itâs quite long.
2/n
RESEARCH - RCTs
In trials, VCs appear to be safe, effective & popular but almost all RCTs were confided to highly selected patients with chronic stable conditions. Most RCT evidence is irrelevant to the current acute, escalating situation.
RESEARCH - RCTs
In trials, VCs appear to be safe, effective & popular but almost all RCTs were confided to highly selected patients with chronic stable conditions. Most RCT evidence is irrelevant to the current acute, escalating situation.
3/n
RESEARCH â QUALITATIVE CASE STUDIES
Introducing VC in real-world settings is a complex change that disrupts roles, relationships and routines. It is more resource-intensive and takes longer than most people anticipate, and failure is common.
RESEARCH â QUALITATIVE CASE STUDIES
Introducing VC in real-world settings is a complex change that disrupts roles, relationships and routines. It is more resource-intensive and takes longer than most people anticipate, and failure is common.
4/n
RESEARCH â QUALITATIVE INTERVIEWS
The commonest reason why clinicians are reluctant to consult via video is professional concerns about quality, safety and accountability. Whether justified or not, these can be a major barrier to scale-up.
RESEARCH â QUALITATIVE INTERVIEWS
The commonest reason why clinicians are reluctant to consult via video is professional concerns about quality, safety and accountability. Whether justified or not, these can be a major barrier to scale-up.
5/n
CLINICAL CONSIDERATIONS
An important clinical indication for VC is when the clinician is self-isolating following a possible COVID contact or with symptoms.
CLINICAL CONSIDERATIONS
An important clinical indication for VC is when the clinician is self-isolating following a possible COVID contact or with symptoms.
6/n
CLINICAL
COVID-related requests from patients for a VC may include for general advice (-> website or phone message), anxiety (-> phone or VC), mild symptoms (VC may be useful), severe symptoms (initial VC may reduce need to visit).
CLINICAL
COVID-related requests from patients for a VC may include for general advice (-> website or phone message), anxiety (-> phone or VC), mild symptoms (VC may be useful), severe symptoms (initial VC may reduce need to visit).
7/n
CLINICAL
Non-COVID consults for which VC may be appropriate include chronic disease reviews (especially if patients have kit at home), counselling /other talking therapy, administrative (eg sick notes), some medication reviews, and triage.
CLINICAL
Non-COVID consults for which VC may be appropriate include chronic disease reviews (especially if patients have kit at home), counselling /other talking therapy, administrative (eg sick notes), some medication reviews, and triage.
8/n
CLINICAL
In complex patients, there may be a trade-off between coming to clinic and staying at home (e.g. in some frail older patients with multi-morbidity, advantages of VC may outweigh its known limitations). Make case-based judgements.
CLINICAL
In complex patients, there may be a trade-off between coming to clinic and staying at home (e.g. in some frail older patients with multi-morbidity, advantages of VC may outweigh its known limitations). Make case-based judgements.
9/n
CLINICAL
VC is unlikely to be appropriate for severely ill patients, where an internal examination canât be deferred, where co-morbidities (eg confusion) affect the patientâs ability to use technology (unless there are relatives to help).
CLINICAL
VC is unlikely to be appropriate for severely ill patients, where an internal examination canât be deferred, where co-morbidities (eg confusion) affect the patientâs ability to use technology (unless there are relatives to help).
10/n
CLINICAL
Video should supplement, not replace, the telephone, for which there is existing experience and guidance (see for example NHS England https://www.england.nhs.uk/wp-content/uploads/2016/03/releas-capcty-case-study-2-183.pdf).
CLINICAL
Video should supplement, not replace, the telephone, for which there is existing experience and guidance (see for example NHS England https://www.england.nhs.uk/wp-content/uploads/2016/03/releas-capcty-case-study-2-183.pdf).
11/n
TECHNICAL ISSUES
Technological solutions to support VCs are improving all the time. Dependability and technical quality are important for an effective, safe clinical consultation. @AttendAnywhere, used in Scotland, is one such product (but not the only one).
TECHNICAL ISSUES
Technological solutions to support VCs are improving all the time. Dependability and technical quality are important for an effective, safe clinical consultation. @AttendAnywhere, used in Scotland, is one such product (but not the only one).
12/n
TECHNICAL
Many solutions that support VCs (video consultations) were originally designed for video *conferences*. These can be cumbersome to use and interactionally awkward. They may require software downloads that breach local IG rules.
TECHNICAL
Many solutions that support VCs (video consultations) were originally designed for video *conferences*. These can be cumbersome to use and interactionally awkward. They may require software downloads that breach local IG rules.
13/n
STRATEGIC ISSUES
When scaling up VC, be clear what the change is. This isnât just âimplementing new technologyâ; itâs *introducing major changes to roles, relationships and workflows*. It will be difficult and resource-intensive.
STRATEGIC ISSUES
When scaling up VC, be clear what the change is. This isnât just âimplementing new technologyâ; itâs *introducing major changes to roles, relationships and workflows*. It will be difficult and resource-intensive.
14/n
STRATEGIC
Assign national and local strategic leads. Ensure that the change is championed and positively communicated by local opinion leaders. Attend to the overall narrative within which the change is framed.
STRATEGIC
Assign national and local strategic leads. Ensure that the change is championed and positively communicated by local opinion leaders. Attend to the overall narrative within which the change is framed.
15/n
STRATEGIC
Given that clinical resistance is likely to be driven by concerns about quality, safety and accountability, get professional bodies and defence societies (nursing as well as medical) on board as a priority.
STRATEGIC
Given that clinical resistance is likely to be driven by concerns about quality, safety and accountability, get professional bodies and defence societies (nursing as well as medical) on board as a priority.
16/n
STRATEGIC
Complex change is hard. It happens more readily if organisations network. Establish an online community of practice for sharing ideas, concerns and resources. Capture and address concerns raised.
STRATEGIC
Complex change is hard. It happens more readily if organisations network. Establish an online community of practice for sharing ideas, concerns and resources. Capture and address concerns raised.
17/n
OPERATIONAL
Visit each organisation (e.g. GP practice) to address both technical issues (e.g. assess technical readiness for VC, install monitors) and operational ones (e.g. identify and redesign workflows).
OPERATIONAL
Visit each organisation (e.g. GP practice) to address both technical issues (e.g. assess technical readiness for VC, install monitors) and operational ones (e.g. identify and redesign workflows).
18/n
OPERATIONAL
Make resource available for organisations to urgently release staff from other duties and give them dedicated time (ideally 100% of their time) to deliver and monitor the change.
OPERATIONAL
Make resource available for organisations to urgently release staff from other duties and give them dedicated time (ideally 100% of their time) to deliver and monitor the change.
19/n
OPERATIONAL
Ensure that every organisation is set up to monitor its progress and adjust accordingly. Metrics and aspects of the PDSA cycle may need to be collectively identified and shaped.
OPERATIONAL
Ensure that every organisation is set up to monitor its progress and adjust accordingly. Metrics and aspects of the PDSA cycle may need to be collectively identified and shaped.
20/20
REFERENCES
No time now to link all the references that informed this thread. My own teamâs work on VCs is mostly on my Google Scholar page. Will pen editorial soon with other refs in. Thanks to @clareupnorth and others for input.
Ends
REFERENCES
No time now to link all the references that informed this thread. My own teamâs work on VCs is mostly on my Google Scholar page. Will pen editorial soon with other refs in. Thanks to @clareupnorth and others for input.
Ends
