Video consultations – a guide for healthcare managers

Organizational structure and digital competencies

Ensuring digital competence among clinicians, therapists, patients, and their relatives is critical for leveraging the benefits of video consultations. This mode of interaction demands distinct competencies compared to physical consultations. Healthcare professionals should possess foundational technical skills to use the video solutions securely and consistently. Furthermore, they must be trained to deliver high-quality video consultations ensuring patient safety. Factors include discerning suitable cases for video consultations and determining the patients’ assistance needs for a successful session.

• Establish a robust support setup within the organization, such as designated super users or first and second support line guidelines.
• Involve your team in developing guidelines and protocols.
• If a specific intervention or patient group is involved, consider creating material to prepare the patients for the video consultation.

The physical environment

• Dedicate specific rooms for video consultations to ensure privacy for patients. Avoid open office environments that can cause background noise and disturbances within the camera’s field of view. Open offices can disturb the citizen (patient), as well as break the confidentiality of the conversation.
• If dedicating rooms isn’t feasible, encourage the use of headphones with a microphone. It improves sound quality and prevents unauthorized individuals from overhearing the conversation.
• Put up an ‘occupied’ sign on the door where the video consultation takes place.
• Display a sign in the background with the organization’s logo, or use a virtual background featuring it.

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

Video consultations are an increasingly prevalent modality of telemedicine, offering numerous benefits to both patients and healthcare systems. For patients, video consultations can save time, facilitate frequent short contacts, and improve safety through quick follow-ups post-hospitalization. These consultations can minimize or even eliminate readmissions. For healthcare systems, video consultations can reduce transportation requirements and curb the spread of infections like Covid-19.

However, video consultations might not be universally suitable. Patients have different life circumstances, health conditions, and coping mechanisms, and these factors should be taken into account when determining the suitability of video consultations.

As a healthcare manager, your role involves providing clear guidelines, protocols, and decision-making tools to support your co-workers. These resources can help your team ensure the delivery of high-standard healthcare via video consultations.

Protocol for patient groups

In the context of healthcare, inclusion and exclusion criteria are the characteristics that determine if a patient is suitable or unsuitable, respectively, for a specific form of treatment or participation in clinical trials. When applied to video consultations, these criteria help identify the most appropriate patients for this format.

For instance, if a patient presents symptoms that could either indicate a minor infection or a potentially serious condition like appendicitis, the ambiguity and potential risk make a physical consultation the safest choice. Video consultations, while not always an equivalent substitute for face-to-face consultations, can be a convenient and less burdensome alternative for many patients, particularly when non-emergency situations are involved.

Inclusion criteria

Inclusion criteria typically encompass clinical and situational factors indicating that a patient would derive benefits from video consultations. For example, consider a patient, living with a chronic but stable condition that necessitates frequent but non-complex follow-ups. Video consultations offers a convenient supplement to traditional in-person treatment.

Similarly, for individuals who lives in rural areas, video consultations could be the optimal solution for healthcare access, effectively breaking down geographical barriers. Inclusion criteria for video consultations may include:

• Patients in stable treatment courses or those managing less severe illnesses.
• Patients with the necessary digital skills, access to the required equipment, and a stable internet connection.

Exclusion criteria

Exclusion criteria aim to identify patients who might not benefit or could potentially be harmed by video consultations.

• Clinical contra indications e.g. outside normal reference requiring immediate physical evaluation, or patients at risk of suicide.
• Patients with complex, multi-system medical issues that require thorough in-person evaluation and treatment are not ideal for video consultations.
• Lack of necessary digital competencies, or the absence of a caregiver who can assist in setting up the required technology.
• Physical or cognitive conditions, such as severe hearing impairment or attention-deficit disorders, which could inhibit effective communication during a video consultation.

In certain scenarios, video consultations may not be suitable due to the nature of the information being communicated. For example, disclosing a critical diagnosis such as cancer is a delicate process that often needs a personal, empathetic touch that a physical meeting can provide. In such sensitive scenarios, ethical considerations become paramount.

Source / References

• Center for Digital Psykiatri
• https://www.bmj.com/content/371/bmj.m3945.full

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 might be the ethical challenges when treating and communicating with patients remotely, such as preserving confidentiality and privacy?

Question 2

In what ways might the patient-provider relationship dynamics be altered in the context of video consultations? What are the potential implications for trust, empathy, and patient engagement?

Question 3

What strategies can be implemented to ensure optimal experiences for both patients and healthcare professionals during video consultations?

Question 4

How might the accessibility and availability of video consultations impact the health equity among different patient groups?

Question 5

What is the role of non-verbal communication in video consultations and how can healthcare professionals adapt to its limitations?

Question 6

How might cultural differences and language barriers influence the effectiveness of video consultations, and what strategies can be implemented to overcome these?

Question 7

How might the principles of beneficence and non-maleficence be impacted in video consultations? For example, consider how decision-making about treatment plans might be affected.

Question 8

How can healthcare professionals ensure they are appropriately understanding and addressing patient concerns during video consultations, given the lack of physical examination and potential communication challenges?

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.

Remember, the appropriateness of video consultation should be considered on a case-by-case basis, considering the patient’s medical condition, their personal circumstances, their comfort with technology, and the quality of care that can be delivered remotely. Here are two examples that shows when video consultations can be suitable and where it is not.

Source / References

• Digis