Assessing Patient Safety in a Pediatric Telemedicine Setting: A Multi-Methods Study

Background: Telemedicine and telephone-triage may compromise patient safety, particularly if urgency is underestimated. We aimed to explore the level of safety of a pediatric telemedicine service, with particular reference to the appropriateness of the medical diagnoses made by the online physicians and the reasonableness of their decisions.

Methods :In the first section of the study, two physicians reviewed a random sample of 339 parent-physician consultations conducted via a pediatric telemedicine service provided by `Clalit` healthcare organization in Israel during 2014-2017. The consultations were analyzed for factors that may have affected the online physicians` decisions, with an emphasis on the appropriateness of the diagnoses and the reasonableness of the decisions. The physicians` decisions were also compared to the subsequent outcomes after each consultation.

The second section of the study (Qualitative) consisted of interviews with 15 physicians who work in the pediatric telemedicine service, to explore their subjective experiences and efforts for assuring patient safety.

Results :High levels of diagnosis appropriateness (98.5%) and decision reasonableness (92%), as well as low levels of false-positive (2.65%) and false-negative (5.3%), good sensitivity (82.85%), and high specificity (96.15%), were demonstrated. A high association between the online decisions and the subsequent outcomes was also observed. The second section of the study presents physicians` means for ensuring high patient safety.

Conclusions :Overall high patient safety in the pediatric tele-triage service was observed. However, decision-makers must strive to implement means for further enhancing the clinicians` ability to reach accurate diagnoses and provide optimal treatments within the tele-triage settings.