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Table 3 Findings eligible for QIs and consequent QIs

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.

  1. aMedical response time is derived from legal requirements for maximum medical response times onshore in Germany