einstein (São Paulo). 11/Dec/2015;13(4):580-6.

Impact of telemedicine in hospital culture and its consequences on quality of care and safety

Milton Steinman, Renata Albaladejo Morbeck, Philippe Vieira Pires, Carlos Alberto Cordeiro Abreu Filho, Ana Helena Vicente Andrade, Jose Claudio Cyrineu Terra, José Carlos Teixeira Junior, Alberto Hideki Kanamura

DOI: 10.1590/S1679-45082015GS2893

ABSTRACT
Objective
To describe the impact of the telemedicine application on the clinical process of care and its different effects on hospital culture and healthcare practice.
Methods
The concept of telemedicine through real time audio-visual coverage was implemented at two different hospitals in São Paulo: a secondary and public hospital, Hospital Municipal Dr. Moysés Deutsch, and a tertiary and private hospital, Hospital Israelita Albert Einstein.
Results
Data were obtained from 257 teleconsultations records over a 12-month period and were compared to a similar period before telemedicine implementation. For 18 patients (7.1%) telemedicine consultation influenced in diagnosis conclusion, and for 239 patients (92.9%), the consultation contributed to clinical management. After telemedicine implementation, stroke thrombolysis protocol was applied in 11% of ischemic stroke patients. Telemedicine approach reduced the need to transfer the patient to another hospital in 25.9% regarding neurological evaluation. Sepsis protocol were adopted and lead to a 30.4% reduction mortality regarding severe sepsis.
Conclusion
The application is associated with differences in the use of health services: emergency transfers, mortality, implementation of protocols and patient management decisions, especially regarding thrombolysis. These results highlight the role of telemedicine as a vector for transformation of hospital culture impacting on the safety and quality of care.

Impact of telemedicine in hospital culture and its consequences on quality of care and safety

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