Role of Nurses in Teleconsultation for
patients in remote areasJPNATC experience
Ms Metilda Robin, Dr Deepak AgrawalNursing 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 allpatients 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.
ObservationsTypes 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