From: Quality indicators of telemedical care offshore—a scoping review
Dimensions in Donabedian’s Framework | Findings eligible as future quality indicator | Derived QIs | |
---|---|---|---|
Structure | Existence of reliable, continuous, and transmittable equipment-based, “plug-and-play” monitoring of vital parameters offshore, including 12-lead ECG [4, 21, 22, 24, 28]. | 1 | Reliably transmittable continuous equipment-based monitoring of vital parameters offshore available within 15 min / all medical cases. a |
2 | “Plug-and-Play” telemedical equipment available within 15 min / all telemedical equipment. a | ||
3 | 12-lead ECG/all ECG-machines. | ||
Existence of reliable, high-quality videoconferencing system [24]. | 4 | High-quality video conferencing systems available within 15 min / all medical cases. a | |
5 | “Plug-and-Play” video conferencing system available within 15 min / all medical cases. a | ||
Development of telemedical care concepts follows a systemic approach [6, 21, 23]. | 6 | Existence of telemedical care concept guidelines / offshore installation. | |
Telemedicine is adjusted to the available bandwidth [6]. | 7 | Number of automatically bandwidth-adjusting telemedical equipment / all telemedical equipment. | |
Subjective and objective medical data as well as patient’s history is accessible through telemedical equipment in real time for several onshore and offshore experts simultaneously and without intermediary [6, 22, 24]. | 8 | Number of telemedically accessible Electronic Health Records (EHR) / number of staff offshore. | |
Major hospital is available 24/7 for specialist consulting. Additional specializations are accessible at all times [4]. | 9 | Number of hours a major hospital is available for synchronous specialist consulting / 24 h | |
Qualification of a teleconsultant physician onshore and medical personnel offshore needs to be defined [4, 25]. | 10 | Teleconsultant physicians according to predefined qualifications / all active teleconsultant physicians. | |
11 | Offshore medical personnel according to predefined qualifications / all active offshore medical personnel. | ||
Process | Personal identification of involved personnel is documented and accessible [6]. | 12 | Number of personnel with documented and accessible professional identification / all involved personnel. |
Communication between and equipment at locations onshore and offshore is standardized [6, 26]. | 13 | Proportion of equipment offshore and onshore that is standardized within the operation / all used equipment. | |
14 | Number of telemedical communication processes between offshore and onshore that are standardized within the operation / all occurring communication processes. | ||
Medical protocols and procedures for the most common cases are defined [20, 26]. | 15 | Most common medical cases, which have defined protocols / 20 most common cases. | |
Development of telemedical care concepts is communicated systematically to all relevant parties [6, 21, 23]. | 16 | Number of changes to telemedical care concepts, that were communicated systematically to all relevant parties / all changes to telemedical care concepts. | |
New workflow processes are aligned with tacit knowledge, experience, and preferred improvements of involved staff [6]. | 17 | Number of new workflow processes that follow participatory design / all new workflows introduced within the last 12 months. | |
New telemedical solutions are aligned with end-user acceptance [22]. | 18 | Number of telemedical solutions aligned with end-user acceptance/ all telemedical solutions in place. | |
Personnel using telemedicine has completed a structured, contextualized telemedical training [17, 18, 25, 27]. | 19 | Number of personnel using telemedicine, that has completed a structured contextualized telemedical training / all personnel using telemedicine. | |
Medical experts are directly included in the decision-making process offshore [6]. | 20 | Number of times, medical experts were directly included in the decision-making process offshore / all consultations. | |
Decisions on telemedical issues are medically driven only [21]. | 21 | Purely medically driven decisions on telemedical issues / all decisions on telemedical issues. | |
In an emergency, medical personnel is assisted offshore in non-medical tasks to be able to focus on medical treatment [21]. | 22 | Number of telemedical cases, in which medical personnel is assisted by non-medical staff / all telemedical cases. | |
Most common medical cases are followed-up to improve procedures and design trainings that improve quality [6]. | 23 | Most common cases, that were followed up to improve procedures and design trainings that improve quality / 20 most common cases. | |
Outcome | Analysis of evacuations in relation to total number of consultations [19]. | 24 | Consultations followed by evacuation / all consultations. |