Fetal telemedicine: a mixed methods evaluation

Bidmead, Elaine, Snaith, Vikki, Robson, Stephen C., Lie, Mabel and Marshall, Alison (2017) Fetal telemedicine: a mixed methods evaluation. In: The Kings Fund Digital Health and Care Congress 2017: Embedding technology in health and social care, 11-12 July 2017, Kings Fund, London, UK. (Unpublished)

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Abstract

Introduction: The complexity of fetal medicine (FM) referrals that can be managed in a district general hospital (DGH) is dependent on the availability of specialist ultrasound expertise. Telemedicine can effectively transfer real-time ultrasound images via video-conferencing.

Aims and objectives: Our objective was to establish a fetal telemedicine service between the obstetric ultrasound unit of a DGH and a specialist FM unit. In evaluating the service we aimed to: (i) determine the technical success of fetal telemedicine; (ii) test the utility of telemedicine technology for training sonographers (iii) assess women’s experiences and acceptance of tele-ultrasound, including a consideration of family costs; (iv) understand the barriers and enablers of technology adoption from the perspectives of clinical stakeholders.

Methods: Women referred for FM consultation from the DGH were seen via a weekly telemedicine service, excluding cases where invasive testing was anticipated. Image and audio quality were rated (using a 5 point scale) following each consultation. The service evaluation employed mixed methods. Referred women were asked to complete a questionnaire following their first consultation, 31 did so and follow-up telephone interviews were undertaken with 16 of them. Semi-structured qualitative interviews were also undertaken with six key clinical stakeholders, two commissioners and two service managers.

Results: 80 women received a telemedicine consultation between October 2015 and September 2016. Of these, 37 cases were new referrals because of fetal anomaly (n=17), including exclusion of abnormal placental invasion (n=11), small-for-gestational age (n=7) and prior history of fetal anomaly (n=2); 43 cases were follow-up consultations. Median gestation was 29 [13-36] weeks. Image quality was of sufficient quality to achieve the aims of the consultation in 79 cases with an image score of 4 [3-5] and audio score of 5 [3-5]. The majority of referred women responded positively to fetal telemedicine; identified benefits included cost savings and less inconvenience from being seen locally. Average journey time to the telemedicine consultation was 20 [4-150] minutes in comparison to an estimated journey time of 238 [120-450] minutes to the FM centre. Estimated family costs for attendance at the FM centre were £95 [20-555]. A range of tangible benefits to DGH staff were identified in interviews with clinicians. Sonographers were upskilled; more involved in women’s pregnancies; and had better access to specialist support. Consultants felt better supported and less isolated professionally, resulting in improved management of high risk pregnancies. Potential barriers included: engagement of DGH executive/management; establishing the video-link; interruption of routine practise. Most challenges were overcome within the pilot.

Conclusions: We have demonstrated that a fetal telemedicine service, that is acceptable to both patients and staff, can be successfully established and used to provide high quality consultations. The service has reduced travel costs and inconvenience for women and has enhanced maternity provision at the DGH.

Item Type: Conference or Workshop Item (Paper)
Departments: Cumbrian Centre for Health Technologies
Depositing User: Elaine Bidmead
Date Deposited: 20 Sep 2017 14:23
Last Modified: 30 Sep 2017 17:48
URI: http://insight.cumbria.ac.uk/id/eprint/3178

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