Video consultations – a sustainable implementation
As a manager, there are a few simple areas that can be addressed to support your co-workers in ensuring a sustainable and safe implementation of video consultations. Below is a description of three areas covering some of the most important aspects.
Organizational structure and digital competencies
It is important to be aware that digital competencies of therapists, clinicians, citizens (patients) and relatives are a crucial prerequisite for achieving the advantages associated with the video consultation format. Video consultations require something different than a physical consultation. The healthcare professionals must have basic technical competencies to use the video solution safely and stably. In addition, they must have knowledge of how to deliver video consultations with high patient safety and professional quality, including, for example, assessing which conversations are suitable for video and the citizen’s (patient’s) need for support to complete a video consultation.
- Make sure that the organization has the necessary support setup. For instance it could be super users or established guidelines for first and second line of support.
- Develop guidelines and protocols with the inclusion of your co-workers.
- If there is a specific intervention or patient group, consider developing some material that can prepare the citizens (patients) for the video consultation. (see box 2 https://www.bmj.com/content/371/bmj.m3945.full)
The physical environment
- Consider establishing rooms dedicated for video consultations to make sure the dialogue can take place with respect to the citizen’s (patient’s) privacy. Avoid an open office environment due to noise and traffic in the background (within the camera angle).
- Open offices can disturb the citizen (patient), as well as break the confidentiality of the conversation. If that is not possible, then it is highly adviced to use headphones with a microphone, which provides significantly better sound quality and may prevent unauthorized persons listening to the conversation.
- If possible put up an ’occupied’-sign on the door to the room where the video consultation takes place
- Put a sign on the wall in the background that shows which organization you belong to (e.g. the logo of your hospital) or make a virtual background with the organization’s logo.
Source / References
- National Guideline for video consultations in the Psychiatry (Vejledning til videosamtaler, Center for Digital Psykiatri).
- https://www3.paho.org/ish/images/docs/covid-19-teleconsultations-en.pdf?ua=1
- https://www.bmj.com/content/371/bmj.m3945.full
Technical infrastructure
All digital communication with citizens (patients) must be compliant with the country’s and organization’s data protection and telehealth regulations (e.g. the European Union’s General Data Protection Regulation guidelines).
In general terms, for a video consultation, it is necessary to have an internet connection, a suitable computer with audio and video capabilities, and transmission devices. A dual monitor setup is also preferable, so one screen can be used for the video consultation and the other for the clinical system. A fast and stable internet and a wired broadband connection is preferred.
If possible provide the room with a dedicated video system. However, if that is not possible, then provide headphones, microphones or a speakerphone to improve the sound quality and user experience.
Make sure that the platform has enough ports/bandwidth to support the amount of expected users.
Having a phone, in case the video conference communication is interrupted, is highly recommended.
Suitable for whom?
Video consultations are one of the most prevalent forms of telemedicine.
Using video consultations provides many advantages for both the citizen (patient) and healthcare systems. It saves time for citizens (patients) and gives the opportunity for frequent short contacts when needed. Video consultations can also improve patient safety, for example with quick follow ups after a hospitalization, so that readmissions are avoided or minimized. However, video consultations might not be for all patient groups. There are some things to consider, when offering video consultations to citizens (patients).
In many countries, the use of video consultations has increased amongst family doctors, hospitals, mental health services and community care services. This can save time as there is no need for transportation, and it will also prevent infections from spreading such as Covid-19.
However, all citizens (patients) are different. They have different life circumstances, health conditions and different tools to deal with their challenges. When working with video consultations it is important to consider what kind of patient groups are suitable and what kind of topic the video consultation is about. Not all messages are suitable for being delivered via video. If it is a matter of sensitive information, for example, informing about severe illness, it might be beneficial to consider an alternative. The citizen (patient) may find it hard to remember what you have talked about and a physical meeting will be preferable. As a healthcare manager, it is important to support your co-workers and provide them with clear guidelines, protocols and decision making tools, that can reassure them in delivering a high standard of healthcare to the citizens (patients).
Protocol for patient groups
A common approach is developing inclusion criterions for whom video consultations can be offered to, and for whom they should not be offered to.
In some cases it might be difficult to distinguish non-emergencies from emergencies through video consultations: if in doubt, err on the side of caution, and have a physical consultation. Video consultations may fall short of the gold standard of face-to-face consultations, but for many citizens (patients), it is more practical and less burdensome to do a video consultation.
Inclusion criteria
Inclusion criteria may be clinical indications deeming that the citizens (patients) are suitable for using video consultations as part of their treatment. In most cases, video consultations are used, as a supplement to the treatment. However, in some cases, video consultations are preferred to a physical meeting. This might be the case for citizens (patients) where mobility is an issue either because of geographical distance, physical, cognitive, or even economical issues. Examples of inclusion criteria are:
- Follow ups or citizens (patients) that are in a stable treatment course, or suffer from less severe illnesses
- Citizens (patients) with the necessary digital competencies and access to the necessary equipment and a stable internet connection
Source / References
Exclusion criteria
These can be clinical indications deeming that citizens (patients) are not suitable for video consultations as a part of their treatment. Examples of exclusion criteria can be:
Clinical contra indications e.g. outside normal reference values or that the citizen (patient) is at risk of committing suicide
The citizen (patient) does not have the necessary digital competencies or relative who can help them set up the equipment
Physical or cognitive conditions that can limit the effectiveness of the video consultation for example limited hearing or lack of a necessary attention span to keep focus during the consultation.
Aspects that require special attention/evaluation are e.g.:
Examination of critical illness or other sensitive topics that can require ethical considerations.
Questions for reflection
When using video consultations, doubts and dilemmas might arise for the healthcare professionals both before, during and after the consultations. These questions can be a good starting point when implementing video consultations and a tool to facilitate a room for reflection.
Question 1
What could be ethical challenges when you treat and communicate with the citizen (patient) at a distance?
Question 2
What happens in the relationship between patient and healthcare professional, when we communicate via a screen?
Question 3
What can be done to ensure, that both patient and healthcare professionals have an optimal experience from a video consultations?
Question 4
What could be ethical challenges when you treat and communicate with the citizen (patient) at a distance?
Question 5
What happens in the relationship between patient and healthcare professional, when we communicate via a screen?
Question 6
What can be done to ensure, that both patient and healthcare professionals have an optimal experience from a video consultations?
Source / References
- DigiS https://www.digis.dk/
Advice
These questions can be used individually or as a starting point for discussion in a group session.They are also printable.
Feel free to think of more questions.
