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