Role of Nurses in Teleconsultation forpatients in remote areas JPNATC experience Ms Metilda Robin, Dr Deepak Agrawal 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 long distances for follow up visits.• This increases the socio-economic load on the families.• Scarcity of specialist doctors in rural areas• Local doctors unable to attend to simple queries of these patients
BACKGROUND• Mobile penetration in India exceeds 90% – The subscriber base in wireless segment increased to 563.73 million in February (TRAI- march 2010)• Almost every family has access to mobile• Pilot study at JPNATC shows that all patients could give a mobile number at the time of registration
INTRODUCTION• Although Call-centres are common in commercial industries like telecom, the concept has been alien to hospitals.• Hospitals usually have reception desks which manage general enquiries and appointments.
INTRODUCTION• An integrated call-centre on the other hand manages extensive backend administrative chores and services besides providing a host of patient related activities on a common platform.• JPN Apex Trauma Centre has a mature EMR system along with integrated call centre
JPNATC-Call centre• Call Centre agents are able to handle basic queries and asked the patient to attend OPD/ see local doctor for all other queries.• It was envisaged to have a special cadre of nurses who would form a middle layer for these type of queries
Aims & Objectives• To evaluate a pilot system of teleconsultation using nurses to handle patient queries.
Methodology:• Prospective study was Conducted in JPNATC ,AIIMS over 6 months period (MArch- August 2011).• JPNATC has a call center which provides appointment for follow up patients & also respond to basic queries of patients.
Methodology• New software introduced in JPNATC (New Delhi) & call centre (Noida) in MArch 2011 – Call can be transferred to any phone in JPNATC – Nurse has access to agent screen in JPNATC – Calling party cannot access nurses number
• New Cadre of Nurses created called Nurse Informatics specialists (NIS).• Posted in ED round the clock• Job responsibilities include receiving patient 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 queries transfers call to NIS.• NIS understands query, opens patients electronic chart and goes through the patient condition• Discusses query with concerned doctor in ED (NS, Ortho, Surgery, Med)
Workflow (contd)• Asks Call centre to patch call with patient and gives answer to query.• Types a ‘teleconsult’ note in CPRS (EMR) detailing the query & response.
Observation• Study period was of 6 months (March- Aug2011).• Total incoming calls received in our call center were ------.• Of these 64 cases were diverted to NIS .
Observations• Of the 64 cases received by NIS, 55(86%) cases were rectified & Solved by the nurse at their level itself• 9 (14%) cases were further discussed with concerned doctors
Observations• 26 (41%) cases were related to orthopedics• 20(31%) cases were of neurosurgery dept• 14(22%) cases were of surgery• 4(6%) cases of other departments.
Observations Types of queries• 40 (63%) medication queries• 6(9%) cases related to symptoms/ signs• 10 (16%)cases related to appointments• 8(13%) cases others.
Conclusions• Nurses can play a extremely important role in follow up queries of patients• Our study shows that almost 90% of all queries can be handled at the nurse level itself.
• Use of Computerised Medical records has a vital role to enable quick briefing of case history by the medical personnel at the time of call.• This project has the potential to revolutionize health care delivery in developing countries like India