Telemedicine in paediatric emergency care: A systematic review

2021 ◽  
pp. 1357633X2110101
Author(s):  
Aditi Mitra ◽  
Rubina Veerakone ◽  
Kathleen Li ◽  
Tyler Nix ◽  
Andrew Hashikawa ◽  
...  
Keyword(s):  
Systematic Review ◽  
Patient Satisfaction ◽  
Emergency Care ◽  
Cost Savings ◽  
Process Measures ◽  
Paediatric Emergency ◽  
Paediatric Emergency Care ◽  
Therapeutic Decision Making ◽  
The Impact

Introduction The impact of telemedicine on the access and quality of paediatric emergency care remains largely unexplored because most studies to date are focused on adult emergency care. We performed a systematic review of the literature to determine if telemedicine is effective in improving quality of paediatric emergency care with regards to access, process measures of care, appropriate disposition, patient-centred outcomes and cost-related outcomes. Methods We developed a systematic review protocol in accordance with PRISMA (Preferred Reporting Items for Systematic Review) guidelines. We included studies that evaluated the impact of synchronous and asynchronous forms of telemedicine on patient outcomes and process measures in the paediatric emergency care setting. Inclusion criteria were study setting, study design, intervention type, age, outcome measures, publication year and language. Results Overall, 1.9% (28/1434) studies met study inclusion and exclusion criteria. These studies revealed that telemedicine increased accuracy of patient assessment in the pre-clinical setting, improved time-to disposition, guided referring emergency department (ED) physicians in performing appropriate life-saving procedures and led to cost savings when compared to regular care. Studies focused on telepsychiatry demonstrated decreased length of stay (LOS), transfer rates and improved patient satisfaction scores. Discussion Our comprehensive review revealed that telemedicine enhances paediatric emergency care, enhances therapeutic decision-making and improves diagnostic accuracy, and reduces costs. Specifically, telemedicine has its most significant impact on LOS, access to specialized care, cost savings and patient satisfaction. However, there was a relative lack of randomized control trials, and more studies are needed to substantiate its impact on morbidity and mortality.

Validity of triage systems for paediatric emergency care: a systematic review

2017 ◽  
Vol 34 (11) ◽  
pp. 711-719 ◽  
Author(s):  
Maria Clara de Magalhães-Barbosa ◽  
Jaqueline Rodrigues Robaina ◽  
Arnaldo Prata-Barbosa ◽  
Claudia de Souza Lopes
Keyword(s):  
Systematic Review ◽  
Emergency Care ◽  
Paediatric Emergency ◽  
Paediatric Emergency Care

scholarly journals A systematic review of the impact of nurse practitioners on cost, quality of care, satisfaction and wait times in the emergency department

CJEM ◽  
2007 ◽  
Vol 9 (04) ◽  
pp. 286-295 ◽  
Author(s):  
Alix J.E. Carter ◽  
Alecs H. Chochinov
Keyword(s):  
Systematic Review ◽  
Emergency Department ◽  
Patient Satisfaction ◽  
Quality Of Care ◽  
Nurse Practitioners ◽  
Census Data ◽  
Medical Community ◽  
Wait Times ◽  
The Impact

ABSTRACT Introduction: US emergency personnel cared for 106% more patients in 1990 than they did in 1980, and national emergency department census data show that 60%–80% of those patients presented with non-urgent or minor medical problems. The hiring of nurse practitioners (NPs) is one proposed solution to the ongoing overcrowding and physician shortage facing emergency departments (EDs). Methods: We conducted a systematic review of MEDLINE and Cinahl to find articles that discussed NPs in the ED setting, looking specifically at 4 key outcome measures: wait times, patient satisfaction, quality of care and cost effectiveness. Results: Although some questions remain, a review of the literature suggests that NPs can reduce wait times for the ED, lead to high patient satisfaction and provide a quality of care equal to that of a mid-grade resident. Cost, when compared with resident physicians, is higher; however, data comparing to the hiring additional medical professionals is lacking. Conclusion: The medical community should further explore the use of NPs, particularly in fast track areas for high volume departments. In rural areas, NPs could supplement overextended physicians and allow health centres to remain open when they might otherwise have to close. These strategies could improve access to care and patient satisfaction for selected urban and rural populations as well as make the best use of limited medical resources.

scholarly journals Impact of GP gatekeeping on quality of care, and health outcomes, use, and expenditure: a systematic review

2019 ◽  
Vol 69 (682) ◽  
pp. e294-e303 ◽  
Author(s):  
Poompong Sripa ◽  
Benedict Hayhoe ◽  
Priya Garg ◽  
Azeem Majeed ◽  
Geva Greenfield
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Patient Satisfaction ◽  
Quality Of Care ◽  
Health Outcomes ◽  
Direct Access ◽  
Cochrane Library ◽  
Patients With Cancer ◽  
The Impact

BackgroundGPs often act as gatekeepers, authorising patients’ access to specialty care. Gatekeeping is frequently perceived as lowering health service use and health expenditure. However, there is little evidence suggesting that gatekeeping is more beneficial than direct access in terms of patient- and health-related outcomes.AimTo establish the impact of GP gatekeeping on quality of care, health use and expenditure, and health outcomes and patient satisfaction.Design and settingA systematic review.MethodThe databases MEDLINE, PreMEDLINE, Embase, and the Cochrane Library were searched for relevant articles using a search strategy. Two authors independently screened search results and assessed the quality of studies.ResultsElectronic searches identified 4899 studies (after removing duplicates), of which 25 met the inclusion criteria. Gatekeeping was associated with better quality of care and appropriate referral for further hospital visits and investigation. However, one study reported unfavourable outcomes for patients with cancer under gatekeeping, and some concerns were raised about the accuracy of diagnoses made by gatekeepers. Gatekeeping resulted in fewer hospitalisations and use of specialist care, but inevitably was associated with more primary care visits. Patients were less satisfied with gatekeeping than direct-access systems.ConclusionGatekeeping was associated with lower healthcare use and expenditure, and better quality of care, but with lower patient satisfaction. Survival rate of patients with cancer in gatekeeping schemes was significantly lower than those in direct access, although primary care gatekeeping was not otherwise associated with delayed patient referral. The long-term outcomes of gatekeeping arrangements should be carefully studied before devising new gatekeeping policies.

Reliability of triage systems for paediatric emergency care: a systematic review

2019 ◽  
Vol 36 (4) ◽  
pp. 231-238 ◽  
Author(s):  
Maria Clara Magalhães-Barbosa ◽  
Jaqueline Rodrigues Robaina ◽  
Arnaldo Prata-Barbosa ◽  
Claudia de Souza Lopes
Keyword(s):  
Systematic Review ◽  
Latin American ◽  
Emergency Care ◽  
Health Sciences ◽  
Cochrane Library ◽  
Perfect Agreement ◽  
Triage System ◽  
Manchester Triage System ◽  
Paediatric Emergency ◽  
Paediatric Emergency Care

ObjectiveTo present a systematic review on the reliability of triage systems for paediatric emergency care.MethodsA search of MEDLINE, Cochrane Library, Latin American and Caribbean Health Sciences Literature, Scientific Electronic Library Online, Nursing Database Index and Spanish Health Sciences Bibliographic Index for articles in English, French, Portuguese or Spanish was conducted to identify reliability studies of five-level triage systems for patients aged 0–18 years published up to April 2018. Two reviewers performed study selection, data extraction and quality assessment as recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.ResultsTwenty studies on nine triage systems were selected: the National Triage System (n=1); the Australasian Triage Scale (n=3); the paediatric Canadian Triage and Acuity Scale (PedCTAS) (n=5); the Manchester Triage System (MTS) (n=1); the Emergency Severity Index (ESI) (n=5); an adaptation of the South African Triage Scale for the Princess Marina Hospital in Botswana (n=1); the Soterion Rapid Triage System (n=1); the Rapid Emergency Triage and Treatment System-paediatric version (n=2); the Paediatric Risk Classification Protocol (n=1). Ten studies were performed with actual patients, while the others used hypothetical scenarios. The studies were rated low (n=14) or moderate (n=6) quality. Kappa was the most used statistic, although many studies did not specify the weighting. PedCTAS, MTS and ESI V.4 exhibited substantial to almost perfect agreement in moderate quality studies.ConclusionsThere is some evidence on the reliability of the PedCTAS, MTS and ESI V.4, but most studies are limited to the countries where they were developed. Efforts are needed to improve the quality of the studies, and cross-cultural adaptation of those tools is recommended in countries with different professional qualification and sociocultural contexts.

scholarly journals The impact of interventions on management of frailty in hospitalized frail older adults: a systematic review and meta-analysis

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Zahra Rezaei-Shahsavarloo ◽  
Foroozan Atashzadeh-Shoorideh ◽  
Robbert J. J. Gobbens ◽  
Abbas Ebadi ◽  
Gholamreza Ghaedamini Harouni
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Patient Satisfaction ◽  
Older People ◽  
Meta Analysis ◽  
Clinical State ◽  
Frail Older Adults ◽  
Hospitalized Older Adults ◽  
The Impact

Abstract Background One of the most challenging issues for the elderly population is the clinical state of frailty. Frailty is defined as a cumulative decline across psychological, physical, and social functioning. Hospitalization is one of the most stressful events for older people who are becoming frail. The aim of the present study was to determine the effectiveness of interventions focused on management of frailty in hospitalized frail older adults. Methods A systematic review and meta-analysis of research was conducted using the Medline, Embase, Cochrane, ProQuest, CINAHL, SCOPUS and Web of Science electronic databases for papers published between 2000 and 2019. Randomized controlled studies were included that were aimed at the management of frailty in hospitalized older adults. The outcomes which were examined included frailty; physical, psychological, and social domains; length of stay in hospital; re-hospitalization; mortality; patient satisfaction; and the need for post discharge placement. Results After screening 7976 records and 243 full-text articles, seven studies (3 interventions) were included, involving 1009 hospitalized older patients. The quality of these studies was fair to poor and the risk of publication bias in the studies was low. Meta-analysis of the studies showed statistically significant differences between the intervention and control groups for the management of frailty in hospitalized older adults (ES = 0.35; 95% CI: 0. 067–0.632; z = 2.43; P < 0.015). However, none of the included studies evaluated social status, only a few of the studies evaluated other secondary outcomes. The analysis also showed that a Comprehensive Geriatric Assessment unit intervention was effective in addressing physical and psychological frailty, re-hospitalization, mortality, and patient satisfaction. Conclusions Interventions for hospitalized frail older adults are effective in management of frailty. Multidimensional interventions conducted by a multidisciplinary specialist team in geriatric settings are likely to be effective in the care of hospitalized frail elderly. Due to the low number of RCTs carried out in a hospital setting and the low quality of existing studies, there is a need for new RCTs to be carried out to generate a protocol appropriate for frail older people.

scholarly journals Impacts of Orthognathic Surgery on Patient Satisfaction, Overall Quality of Life, and Oral Health-Related Quality of Life: A Systematic Literature Review

2019 ◽  
Vol 2019 ◽  
pp. 1-15 ◽  
Author(s):  
Rodrigo Zamboni ◽  
Flávio Renato Reis de Moura ◽  
Myrian Camara Brew ◽  
Elken Gomes Rivaldo ◽  
Marcylene Arruda Braz ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Patient Satisfaction ◽  
Oral Health ◽  
Orthognathic Surgery ◽  
Short Form ◽  
Life Questionnaire ◽  
The Impact ◽  
Present Systematic Review

Several treatments have been suggested to correct dentofacial abnormalities, including orthognathic surgery. The aim of the present systematic review was to assess the impact of orthognathic surgery on patient satisfaction, overall quality of life, quality of life related to oral health—and to orthognathic surgery in particular—among adult patients. Two investigators independently reviewed the available literature in the databases PubMed/MEDLINE, LILACS, SciELO, EMBASE, Trip, and Google Scholar (gray literature) based on the keywords “orthognathic surgery” and “quality of life.” An analysis of bias was performed based on the MINORS (methodological index for nonrandomized studies). A total of 245 relevant studies were retrieved from the databases, and 6 additional studies were located after a manual search of the references. Following selection based on titles, abstracts, and full-text analysis, 30 studies were included in the present systematic review. To evaluate quality of life before and after orthognathic surgery, 12 studies applied the surgery-related Orthognathic Quality of Life Questionnaire (OQLQ), 12 used the Oral Health Impact Profile (OHIP-14), and 4 used the Short Form Health Survey (SF-36). Orthognathic surgery results in improvements in quality of life both physically and psychosocially after surgery and is associated with high rates of patient satisfaction.

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