Presentation
DH15 - Patient Perceptions of Teamwork in Telehealth Appointments
SessionPoster Session 1
DescriptionBackground/Purpose
Telehealth use—including videoconferencing and telephone-based interactions—expanded rapidly during the COVID-19 pandemic to extend access to healthcare while limiting traditional in-person encounters. This method of delivering healthcare has changed the way that patients interact with their medical providers to receive patient care in lieu of a more traditional in-person office visit. We know that teamwork is important to providing good patient care in traditional models of care but there is less research on teamwork during virtual care encounters. Factors such as communication, leadership, team orientation, and team cohesion may be important during telemedicine appointment (McVey & Katigbak, 2024). With patients at the center of the care team, we wanted to understand their experience of teamwork in virtual care settings. The purpose of this study was to explore patient experiences of teamwork when they had telehealth appointments with their care team.
Methods
The study design was a qualitative research study conducted with individual semi-structured interviews. The Office of Regulatory Affairs approved this as an exempt research study (IRB# 164-21-EX). Study participants were patients at a large midwestern academic medical center who had participated in two or more telehealth appointments with their medical care team in the last year. Participants were recruited using the institution’s opt-in to research recruitment system (where patients have opted-in to be contacted about research opportunities) and received up to three emails with information about the study.
Participants scheduled a time with a study researcher to complete an individual 30-45 minute semi-structured interview conducted via Zoom. Prior to the interview, participants received a copy of the interview questions and the consent form. Informed consent was obtained from all participants prior to beginning the interview. Interview topics included identifying care team members, walking through their experience with the telehealth appointment process from scheduling through follow-up, and good and bad experiences of teamwork during telehealth appointments. Interviews were recorded using Zoom cloud recording and an initial transcript was created using Zoom cloud transcription. Transcripts were then verified verbatim and de-identified to protect patient confidentiality. Transcripts served as the study data. This study used a thematic analysis (Braun & Clark, 2006) where transcripts were independently reviewed by two research team members to identify initial teamwork processes and common themes among the participants about working with their care team. Research team members then met for discussion to come to consensus on any discrepancies.
Results
Forty-four individuals expressed interest in participating in the study, and 19 participated in a study interview. We excluded one participant’s interview from the data set because the participant shared experiences about telehealth appointments that took place in a group setting whereas all other participants telehealth appointments were conducted on an individual level. All participants identified themselves as white and not Hispanic or Latino, 63% as female, with an average age of 45 years old. The average number of telehealth appointments per participant in the last year was eight.
Participants typically reported that care team members they interacted with during a telehealth appointment included either a physician/advanced practice provider or a specialist. Other team members involved during telehealth scheduling, preparation, and follow-up included nurses and patient care technicians.
Overall, the most common teamwork processes experienced by participants were communication and monitoring/adjusting. Communication, which includes the exchange of information between team members, whether it be verbal or via electronic means, was most prevalent during the telehealth stages of scheduling, preparation, appointment, and follow-up while monitoring/adjusting was most prevalent during telehealth preparation and appointment. While participants highlighted verbal communication as an essential aspect of teamwork during telehealth appointments, they also reported asynchronous communication via the online patient portal as a key component of teamwork that was most utilized during the telehealth scheduling, patient preparation, and follow-up phases. This asynchronous communication by the participants occurred largely by sending information or pictures to their care team ahead of their scheduled appointment time. Participants also reported that the online patient portal was essential to help facilitate effective teamwork in general because it allowed the participants to review their health history, old appointment notes, laboratory results, complete electronic check-in, and receive reminders for upcoming appointments.
Monitoring/adjusting, which involves the collection and analysis of information to inform changes to healthcare goals, was identified as another critical teamwork process for telehealth preparation and appointments. Participants reported that monitoring the status of their medical condition and reporting any changes to their care team was a task they took ownership of, while making adjustments (e.g., changes in medication regimen or treatment plan) was a responsibility shouldered by healthcare team members.
A few participants reported that adaptability was an important teamwork process during telehealth scheduling, particularly when there was a need to be seen more urgently and there were no in-person appointment times available but there was availability to squeeze in a telehealth appointment with their care team. A few participants also reported that handoff/interteam communication, which included the asynchronous sharing of information between care team members (including relevant specialists) was an essential function of perceived provider preparation for telehealth appointments. However, overall patients did not feel like this was something that members of the care team did consistently in advance of their appointments.
Conclusions and Key Takeaways
The findings of this study reinforce the importance of good communication between care team members and patients across all stages of telehealth appointments to ensure everyone is on the same page regarding the broader goals of medical care. Ensuring clear and open communication can help build trust, clarify expectations, and address any concerns or questions that may arise during the telehealth appointment. The online patient portal was a critical mechanism to support asynchronous team communication between patients and their care team. This platform offers patients secure access to their health records, ability to message care team providers, schedule appointments, and receive important reminders regarding upcoming appointments, in addition to a better general understanding of their unique healthcare situation. As a result of these various functionalities, it is crucial for healthcare providers to ensure that patients receive adequate training and education on how to effectively navigate the online patient portal and when it is appropriate to use for asynchronous communication with their care team.
An opportunity for improvement that emerged from this study was the need for resources to facilitate pre-appointment information gathering so that all team members are well-prepared to engage in a meaningful telehealth appointment. A pre-appointment checklist of all necessary components of a telehealth visit (e.g., for patients – recent set of vital signs, any changes to health conditions, new symptoms, updates from any other provider appointments; for providers—patients' electronic chart has been reviewed including laboratory results and medications the patient is taking) could be developed and tested to evaluate its impact on improving effective patient and provider telehealth appointment preparation. Another area for improvement is ensuring that providers are consistently engaging in effective handoff/interterm communication with other members of the care team as participants highlighted this as an area of frustration and a hindrance to effective telehealth appointments. A post-telehealth appointment notification that prompts healthcare providers (or their team) to send post-appointment documents to other members of the patients care team, so everyone has the most current information about the patient, could be developed and tested as a mechanism to facilitate communication amongst the broader care team.
Telehealth use—including videoconferencing and telephone-based interactions—expanded rapidly during the COVID-19 pandemic to extend access to healthcare while limiting traditional in-person encounters. This method of delivering healthcare has changed the way that patients interact with their medical providers to receive patient care in lieu of a more traditional in-person office visit. We know that teamwork is important to providing good patient care in traditional models of care but there is less research on teamwork during virtual care encounters. Factors such as communication, leadership, team orientation, and team cohesion may be important during telemedicine appointment (McVey & Katigbak, 2024). With patients at the center of the care team, we wanted to understand their experience of teamwork in virtual care settings. The purpose of this study was to explore patient experiences of teamwork when they had telehealth appointments with their care team.
Methods
The study design was a qualitative research study conducted with individual semi-structured interviews. The Office of Regulatory Affairs approved this as an exempt research study (IRB# 164-21-EX). Study participants were patients at a large midwestern academic medical center who had participated in two or more telehealth appointments with their medical care team in the last year. Participants were recruited using the institution’s opt-in to research recruitment system (where patients have opted-in to be contacted about research opportunities) and received up to three emails with information about the study.
Participants scheduled a time with a study researcher to complete an individual 30-45 minute semi-structured interview conducted via Zoom. Prior to the interview, participants received a copy of the interview questions and the consent form. Informed consent was obtained from all participants prior to beginning the interview. Interview topics included identifying care team members, walking through their experience with the telehealth appointment process from scheduling through follow-up, and good and bad experiences of teamwork during telehealth appointments. Interviews were recorded using Zoom cloud recording and an initial transcript was created using Zoom cloud transcription. Transcripts were then verified verbatim and de-identified to protect patient confidentiality. Transcripts served as the study data. This study used a thematic analysis (Braun & Clark, 2006) where transcripts were independently reviewed by two research team members to identify initial teamwork processes and common themes among the participants about working with their care team. Research team members then met for discussion to come to consensus on any discrepancies.
Results
Forty-four individuals expressed interest in participating in the study, and 19 participated in a study interview. We excluded one participant’s interview from the data set because the participant shared experiences about telehealth appointments that took place in a group setting whereas all other participants telehealth appointments were conducted on an individual level. All participants identified themselves as white and not Hispanic or Latino, 63% as female, with an average age of 45 years old. The average number of telehealth appointments per participant in the last year was eight.
Participants typically reported that care team members they interacted with during a telehealth appointment included either a physician/advanced practice provider or a specialist. Other team members involved during telehealth scheduling, preparation, and follow-up included nurses and patient care technicians.
Overall, the most common teamwork processes experienced by participants were communication and monitoring/adjusting. Communication, which includes the exchange of information between team members, whether it be verbal or via electronic means, was most prevalent during the telehealth stages of scheduling, preparation, appointment, and follow-up while monitoring/adjusting was most prevalent during telehealth preparation and appointment. While participants highlighted verbal communication as an essential aspect of teamwork during telehealth appointments, they also reported asynchronous communication via the online patient portal as a key component of teamwork that was most utilized during the telehealth scheduling, patient preparation, and follow-up phases. This asynchronous communication by the participants occurred largely by sending information or pictures to their care team ahead of their scheduled appointment time. Participants also reported that the online patient portal was essential to help facilitate effective teamwork in general because it allowed the participants to review their health history, old appointment notes, laboratory results, complete electronic check-in, and receive reminders for upcoming appointments.
Monitoring/adjusting, which involves the collection and analysis of information to inform changes to healthcare goals, was identified as another critical teamwork process for telehealth preparation and appointments. Participants reported that monitoring the status of their medical condition and reporting any changes to their care team was a task they took ownership of, while making adjustments (e.g., changes in medication regimen or treatment plan) was a responsibility shouldered by healthcare team members.
A few participants reported that adaptability was an important teamwork process during telehealth scheduling, particularly when there was a need to be seen more urgently and there were no in-person appointment times available but there was availability to squeeze in a telehealth appointment with their care team. A few participants also reported that handoff/interteam communication, which included the asynchronous sharing of information between care team members (including relevant specialists) was an essential function of perceived provider preparation for telehealth appointments. However, overall patients did not feel like this was something that members of the care team did consistently in advance of their appointments.
Conclusions and Key Takeaways
The findings of this study reinforce the importance of good communication between care team members and patients across all stages of telehealth appointments to ensure everyone is on the same page regarding the broader goals of medical care. Ensuring clear and open communication can help build trust, clarify expectations, and address any concerns or questions that may arise during the telehealth appointment. The online patient portal was a critical mechanism to support asynchronous team communication between patients and their care team. This platform offers patients secure access to their health records, ability to message care team providers, schedule appointments, and receive important reminders regarding upcoming appointments, in addition to a better general understanding of their unique healthcare situation. As a result of these various functionalities, it is crucial for healthcare providers to ensure that patients receive adequate training and education on how to effectively navigate the online patient portal and when it is appropriate to use for asynchronous communication with their care team.
An opportunity for improvement that emerged from this study was the need for resources to facilitate pre-appointment information gathering so that all team members are well-prepared to engage in a meaningful telehealth appointment. A pre-appointment checklist of all necessary components of a telehealth visit (e.g., for patients – recent set of vital signs, any changes to health conditions, new symptoms, updates from any other provider appointments; for providers—patients' electronic chart has been reviewed including laboratory results and medications the patient is taking) could be developed and tested to evaluate its impact on improving effective patient and provider telehealth appointment preparation. Another area for improvement is ensuring that providers are consistently engaging in effective handoff/interterm communication with other members of the care team as participants highlighted this as an area of frustration and a hindrance to effective telehealth appointments. A post-telehealth appointment notification that prompts healthcare providers (or their team) to send post-appointment documents to other members of the patients care team, so everyone has the most current information about the patient, could be developed and tested as a mechanism to facilitate communication amongst the broader care team.
Event Type
Poster Presentation
TimeMonday, March 314:45pm - 6:15pm EDT
LocationFrontenac Foyer
Digital Health (DH)
Simulation and Education (SE)
Hospital Environments (HE)
Medical and Drug Delivery Devices (MDD)
Patient Safety and Research Initiatives (PS)