Role of Nurses inTeleconsultation for patientsin remote areasJPNATC experienceDr Deepak Agrawal, Ms Metilda Robin,Nursing Informatics Specialists Program,Department of IT,JPNA Trauma centre, AIIMS, N Delhi
BACKGROUND• Bedridden and wheelchair bound patients(head & spinal injuries) have to travel longdistances for follow up visits.• This increases the socio-economic load onthe families.• Scarcity of specialist doctors in rural areas• Local doctors unable to attend to simplequeries of these patients
BACKGROUND• Mobile penetration in India exceeds90%– The subscriber base in wireless segment increased to 563.73 million in February (TRAI- march 2010)• Almost every family has access tomobile• Pilot study at JPNATC shows that allpatients could give a mobile numberat the time of registration
INTRODUCTION• Although Call-centres are common incommercial industries like telecom,the concept has been alien tohospitals.• Hospitals usually have receptiondesks which manage generalenquiries and appointments.
INTRODUCTION• An integrated call-centre on theother hand manages extensivebackend administrative chores andservices besides providing a host ofpatient related activities on acommon platform.• JPN Apex Trauma Centre has amature EMR system along withintegrated call centre
JPNATC-Call centre• Call Centre agents are able to handlebasic queries and asked the patientto attend OPD/ see local doctor forall other queries.• It was envisaged to have a specialcadre of nurses who would form amiddle layer for these type of queries
Aims & Objectives• To evaluate teleconsultation usingnurses to handle patient queries.
Methodology:• Started March 2011• JPNATC has a call center whichprovides appointment for followup patients & also respond tobasic queries of patients.
Methodology• New software introduced in JPNATC(New Delhi) & call centre (Noida) inMArch 2011– Call can be transferred to any phone inJPNATC– Nurse has access to agent screen inJPNATC– Calling party cannot access nursesnumber
• New Cadre of Nurses created calledNurse Informatics specialists(NIS).• Posted in ED round the clock• Job responsibilities include receivingpatient queries (through call centre),coordinating with doctors In ED &resolving the queries.
Workflow• Patient phones call centre (011-40401010)• Agent answers. In case of medical queriestransfers call to NIS.• NIS understands query, opens patientselectronic chart and goes through thepatient condition• Discusses query with concerned doctor inED (NS, Ortho, Surgery, Med)
Workflow (contd)• Asks Call centre to patch call withpatient and gives answer to query.• Types a ‘teleconsult’ note in CPRS(EMR) detailing the query &response.
Observations• Of all calls received by NIS in 2012, 86%cases were rectified & Solved by thenurse at their level itself• 14% cases were further discussed withconcerned doctors
ObservationsTypes of queries• 63% medication queries• 9% cases related to symptoms/ signs• 16% cases related to appointments• 13% cases others.
Conclusions• Telemedicine using Nurses can play aextremely important role in follow upqueries of patients• Our study shows that almost 90% ofall queries can be handled at thenurse level itself.
• Use of Computerised Medical recordshas a vital role to enable quickbriefing of case history by themedical personnel at the time of call.• This project has the potential torevolutionize health care delivery indeveloping countries like India