NURS3002 Utilising Research to Promote Quality in Health Care

Introduction:

In the health care industry, there is a need for ease of working and smooth flow of work that will help in increasing the medical practice and quality of service that is given to the patients. Technology has been advancing by the passing of time, and it has been stated that the use of technology has made life easier in all spheres. Implementing the use of technology in the health care system has been beneficial in improving service to the patient and handling of work by the nurses (Kuehn, 2016). Studies state that telemedicine does have a positive effect on patient care. The topic for this paper is important as there is a need for the implementation of telemedicine as a standard for better health results. For this assignment, the format that has been used is PICO which is a researchable question that will help in good clinical research. For this paper, the PICO question formed is

P (Population): Emergency department patients (Aslam & Emmanuel, 2010).

I (Intervention): Use of telemedicine (Aslam & Emmanuel, 2010).

C (Comparison): No telemedicine (Aslam & Emmanuel, 2010).

O(Outcome): Better health outcomes for patients (Aslam & Emmanuel, 2010).

This is a paper that will report the importance of using technology in the health care industry that will be beneficial to produce patient outcomes that are better than the ones without the use of telemedicine.

Methodology:

In this section, there is a need for proper methods to be adopted to select the paper that is most appropriate to the topic that has been chosen. As there are many studies conducted, a thorough screening process is involved in the selection of the most appropriate paper that will help in increasing the knowledge base of the topic. The table given below includes the search terms that were used to select the appropriate paper.

The articles were screened thoroughly for better representation of the paper that should be chosen for the assignment. The papers that were eliminated in this study was due to the unmatching of the criteria that were set. The papers were eliminated as some of them did not match the criteria of the year that is within the last 10 years of publication. There were papers that were not part of primary research, such as randomised control trial (RCT), cohort study, cross-sectional, or longitudinal study. There were papers that did not use a technological intervention of any kind that is specific to health care. For the exclusion of the papers, the reason was also that some papers did not use any particular population base that could be used. The paper that has been chosen for this study matches all the criteria that are set for the study. This is a paper that has been published in 2019, and it is most relevant in terms of the time of publication along with the topic as it aids in highlighting the use of technology in bettering patient health outcomes. This is a paper that is selected as it ideally highlights the benefits as well as a rationale as to why it should be added in the health care community for the betterment of the patients as well as for the health care workers and practitioners.

Results:

This is a paper that has been selected as the research question that it has formulated is to check the use of telemedicine in the rural emergency departments that is challenging. This is a study that has proposed the use of emergency department-based telemedicine that will improve the quality and timeliness of care in rural emergency departments. The design of this paper is a cohort study, and the cohort studies are an appropriate type of study design as it is known to be advantageous for examining the exposure and examining the outcomes that are produced after a particular intervention is implemented in a population (Song & Chung, 2010). Therefore, this study design is appropriate for the paper.  The setting of the study is the rural parts of northern Australia, and it includes all patients from the emergency department and who have been suffering from myocardial infarction or stroke and have been subscribed to a telemedicine provider. The patients that were subscribed to this telemedicine were only selected for this paper. The cases that were included were from designated critical access hospitals as they use the electronic medical record system for the data collection ended in the year of 2015. A total of 756 subjects were added to the myocardial infarction cohort, and there were 140 that were included in the stroke cohort design. Therefore, the total sample size that was included in this study is 896, and it has been noted in many studies that good sample size is representative of a good study as it indicates that the intervention that is being evaluated is done on a representation of the population (Faber & Fonseca, 2014). All data were collected from the hospitals so that the information from the patients was accurately given, and a record of the telemedicine encounters was determined to check whether the use of telemedicine was done for all the patients.  It was collected manually using the electronic medical records and chart review for variables that were not accurately recorded. The chart review was done by a trained research team member and using a standard case report form. To determine that the cases were using telemedicine and to understand the effectiveness of the technology on the myocardial infarction and stroke patients, the data were analysed with the help of bivariate analysis for both the cardiac and stroke cohorts to compare the care associated characteristics with telemedicine availability and use. The relationship between telemedicine and timeliness parameters were included. The findings of this study stated that for the use of time-sensitive emergency department, the use of telemedicine has resulted in 18.6% of myocardial infarction patients receiving the fibrinolytic therapy in time and it also resulted in 61% of the stroke patients receive the tPA administration in time. For the purpose of the evaluation and analysis of the result, the statistical significance was set at α <0.05 using the two-tailed tests and conducting the analysis using the SAS 9.4 (Mohr et al., 2019). It has been stated that the use of telemedicine has reported being helpful as it is a technology that can address the concerns of the patient during an adverse event that occurs and aid in the care in the pre-hospitalisation phase. It has been noted that the use of telemedicine in this paper has helped in changing the rural system of health care as it has provided multiple reports of different cases where telemedicine has helped in timely suggestion and activation of intervention that has had a direct effect on the hospitalisation morbidity. There are additional studies that have been conducted on the use of telemedicine and the effects on patient outcomes, and it has been stated that the final results of this technology are that it yields positive results on the health outcomes of patients (Poulsen et al., 2015) and it helps in the delivery of good care by the health workers and practitioners.

Discussion:

This paper has addressed a type of health care initiative that is now being recognised in the world as a part of the health care industry. Telemedicine is that technological advancement that is helping in the reduction of the rates of morbidity and mortality in the world. This is a paper that can be stated as a valid paper as it is a research publication that has incorporated the recent findings related to this topic. It has ensured that the results that have been stated in this study are true and proper forms of assessment has been done in order to reach a conclusion for the results that have been depicted. This paper also implies that there are proper elements that have been added to check for the efficiency of the intervention that has been implemented. This is a paper. Therefore, that can be stated to be valid. Regarding biases, it is mainly the tendency that prevents the unprejudiced consideration of a question. This can occur due to an error on the part of the researcher on it can be a deliberate attempt to manipulate the findings to answer the research question. It has been stated that bias has the power to changes the interpretation and the effectiveness of the research carried out. Bias is most commonly seen in the data collection, study design and outcomes (Pannucci & Wilkins, 2010). In this study, there has been no mention of any bias that may be present. However, data collection can have a bias present as there may be manipulation to streamline the data to meet the required outcome that is set. The results of this paper have clearly stated that telemedicine has a beneficial effect on the patient outcome, and it is helpful to the patient as well as the nurse. There have been other studies that were conducted to determine the use of telemedicine and to check its effectiveness. Another study conducted in Australia stated that in remote intensive care units, it is difficult to reduce the rate of morbidity and mortality as there is no or less access to health care services that might be present. With the help of telemedicine, it is possible to provide medical assistance overseas as well. This paper stated that the use of telemedicine was of great assistance as virtual help and consultations were provided to the people that were deprived of medical assistance, and that was helpful for the patient as well as for the health care workers as they were able to gauge and monitor patients far and were able to provide them with efficient health services (Forster et al., 2016). Critically ill patients, when provided with telemedicine, has also responded positively to this intervention that has helped in the betterment of patient health outcomes and establishing benefits for the telemedicine input of reach areas (Panlaqui et al., 2017). The reason why the results of the paper have been critically analysed is essential as there is another study that backs the claim of the use of telemedicine for the betterment of patient outcomes. It has been stated in this study that the use of telemedicine is useful in providing regular health checks to patients that help in proper and accurate monitoring of the progress of the patient. Health checks are part of the health care industry, and it can be possible that they are missed by the patient. However, the implementation of the telemedicine helps in monitoring this, which will help in the maintenance of public health status and is also associated with the high detection of any other medical issues that the patient may be undergoing. This is a technology that should be implemented in all health care institutes to ensure that timely service is provided to all patients (Forster et al., 2016). Therefore, it can be stated that the findings of the paper analysed are accurate in terms of validity. There are certain limitations that have been stated that include that retrospective collection of medical records was done and that restricted the measurements of the medical parameters of those records. The information on the severity of illness was not present as well.

The increase in the burden of diseases is leading the world to a higher rate of mortality and morbidity. The main aim of the health care industry is to provide appropriate and adequate health care intervention to the patients that are suffering and are in desperate condition for medical assistance. The use of telemedicine has been formulated or devised for the sole purpose of making medical assistance available to one and all irrespective of any factors that may create disparities. There are studies that have been conducted that state that there are many benefits of using the telemedicine technology and that it is an underrated and under-explored part of the health care industry. It is, therefore, essential to highlight the uses as well as benefits that will help in the implementation of this technology in different health care sectors to aid in the betterment of the patient health outcomes. Therefore, it can be stated that this is the relevance of the research question that has been asked. There have been recent studies and reports that have highlighted the use of telemedicine as a positive and effective trend in clinical practice. It has been stated that as health care requires precision delivery, the use of telehealth as a method for intervention is now an evidence-based practice that has taken the turn for the better in health services. It is used in many clinical specialities and is implemented across numerous health settings that include the use of a mobile patient centre and virtual medical assistance (Wilson & Maeder, 2015). There is a rising interest in the use of telemedicine as a clinical practice as it has shown to be of tremendous success as a clinical guide. There is a wide scope of telemedicine in the clinical practice that covers mostly all departments of health care service, and it is gradually gaining popularity as it has been stated that the response to medical help in most cases is accurate with the help of telemedicine. With the accurate response to help, the role of the health care provider has widened, and it has become easier to provide adequate help on time that saves the life of a critically ill patient before they enter the hospital for help. Emergency medicine is the most important part of the health care industry, and it has seen a wide expansion after the implementation and adaptation of the telemedicine technology (Parker et al., 2018). Therefore, this report that has been conducted on the effectiveness of technology on the public hand patient health outcomes is a scientific research paper that has been critically analysed and appraised. This paper has highlighted some of the key concepts that are required to be understood in health care. This is a high-value paper that is of level 1 evidence and has great relevance to clinical practice and the health care industry.

References:

Aslam, S., & Emmanuel, P. (2010). Formulating a researchable question: A critical step for facilitating good clinical research. Indian journal of sexually transmitted diseases and AIDS, 31(1), 47–50. https://doi.org/10.4103/0253-7184.69003

Faber, J., & Fonseca, L. M. (2014). How sample size influences research outcomes. Dental press journal of orthodontics, 19(4), 27–29. https://doi.org/10.1590/2176-9451.19.4.027-029.ebo

Forster, A. S., Burgess, C., Dodhia, H., Fuller, F., Miller, J., McDermott, L., & Gulliford, M. C. (2016). Do health checks improve risk factor detection in primary care? Matched cohort study using electronic health records. Journal of Public Health, 38(3), 552-559. doi:10.1093/pubmed/fdv119

Kuehn, B. M. (2016). Telemedicine helps cardiologists extend their reach. Circulation, 134(16), 1189-1191. https://doi.org/10.1161/CIRCULATIONAHA.116.025282

Mohr, N. M., Young, T., Harland, K. K., Skow, B., Wittrock, A., Bell, A., & Ward, M. M. (2019). Telemedicine is associated with faster diagnostic imaging in stroke patients: a cohort study. Telemedicine and e-Health, 25(2), 93-100.  https://doi.org/10.1089/tmj.2018.0013

Panlaqui, O. M., Broadfield, E., Champion, R., Edington, J. P., & Kennedy, S. (2017). Outcomes of telemedicine intervention in a regional intensive care unit: a before and after study. Anaesthesia and intensive care, 45(5), 605-610. https://doi.org/10.1177/0310057X1704500511

Pannucci, C. J., & Wilkins, E. G. (2010). Identifying and avoiding bias in research. Plastic and reconstructive surgery, 126(2), 619–625. https://doi.org/10.1097/PRS.0b013e3181de24bc

Parker,  S., Prince, A., Thomas, L., Song, H., Milosevic, D., & Harris, M. F. (2018). Electronic, mobile and telehealth tools for vulnerable patients with chronic disease: a systematic review and realist synthesis. BMJ open, 8(8), e019192. http://dx.doi.org/10.1136/bmjopen-2017-019192

Poulsen, K. A., Millen, C. M., Lakshman, U. I., Buttner, P. G., & Roberts, L. J. (2015). Satisfaction with rural rheumatology telemedicine service. International journal of rheumatic diseases, 18(3), 304-314. https://doi.org/10.1111/1756-185X.12491

Song, J. W., & Chung, K. C. (2010). Observational studies: cohort and case-control studies. Plastic and reconstructive surgery, 126(6), 2234–2242. https://doi.org/10.1097/PRS.0b013e3181f44abc

Wilson, L. S., & Maeder, A. J. (2015). Recent directions in telemedicine: review of trends in research and practice. Healthcare informatics research, 21(4), 213. https://synapse.koreamed.org/upload/SynapseData/PDFData/1088hir/hir-21-213.pdf

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