Issues in Telerounding Research and Considerations for Future Study
TimeThursday, April 152:00pm - 3:00pm EDT
DescriptionBackground: Telemedicine is a term used to describe any care provided that involves an element of distance from the patient to the provider (World Health Organization, 2020). A variety of virtual clinical functions are incorporated under the term telemedicine, including office visits, triage, and surgery. Patient-provider interactions at a patients’ bedside may also be facilitated virtually via real-time audiovisual communications or robotic systems, which is known as telerounding.
COVID-19 has catalyzed the adoption of telemedical services like telerounding around the world to enable more providers to facilitate care for patients remotely. Healthcare is an evidence-based practice, and as such, is reliant on high-quality research to receive clinical guidance. Despite the increasing prevalence of telerounding, empirical evidence supporting telerounding is sparse and confounded with other telemedical services. Therefore, the purpose of this presentation is to 1) highlight two main challenges associated with recent telerounding research and 2) provide calls to action for future work that can remedy these challenges and improve homogeneity in telerounding research.
Challenge 1. Inconsistencies in Telerounding Research: There is not a consistent definition of telerounding that is shared across articles in the current literature. The term ‘telerounding’ is currently used interchangeably with other services and can refer to in-facility and out-of-facility care. Disparate interpretations of the term telerounding have led to a variety of publications reporting different clinical functions under the same name. This leads to difficulty in performing comparisons across studies, as the characteristics and functions of what is reported as telerounding are highly heterogeneous.
A wide variety of devices are used to facilitate telerounding, including both robotic and nonrobotic systems. Robotic systems can navigate throughout a hospital while being operated entirely remotely, whereas nonrobotic systems require a person on-site to physically move the device to rounding locations. There are different robotic devices at multiple price points that each have varying infrastructure requirements (e.g. wider hallways, different network capabilities, etc.) and operational capabilities (e.g. some may have additional functions outside of visual/audio communication). Likewise, many different platforms are used to facilitate telerounding with nonrobotic systems. Some studies do not report what system was used to enable audio-visual communications with a provider, which makes it difficult to account for this variability in analyses. Currently, researchers performing comparisons across articles are forced to make false-equivalences between telerounding facilitated by all of these systems. This is detrimental, as it may conceal large differences between systems and lead to false conclusions regarding the safety and efficacy of telerounding as a whole.
Challenge 2. Study Design and Reporting Limitations: A prevalent issue with many telerounding articles is the study design, specifically a lack of baseline data. Many organizations may encounter limitations, such as time and urgency that preclude the availability of baseline data. Observational data may be a sufficient solution for the healthcare community short-term, but this does not allow for any meaningful knowledge advancement for the greater scientific community. The lack of baseline comparability is a weakness in many studies reporting the effects of telerounding.
Further, there is very minimal overlap in the clinical and non-clinical outcome measures reported in the published literature. No single outcome is comprehensively reported across all – or even a majority – of telerounding studies. Measures that are reported across a majority of studies are often produced with different tools. Some reported outcomes are so sparse that they only occur once across studies in the current body of literature. This makes it extremely difficult to compare across studies, a benefit that would clearly aid in articulating the effects of telerounding on any specific outcome.
Calls to Action for Future Research: The issues mentioned above make it extremely difficult to compare results across studies and to draw generalizable conclusions regarding the impact of telerounding. Fortunately, many of these issues in the current telerounding literature can be adequately addressed in future studies.
We suggest that the healthcare community adopt a standardized definition of telerounding. Technology is pervasive in healthcare, but its applications are highly varied. These variations should be reflected in terminology that delineates telerounding as a mechanism to augment or replace traditional bedside interactions in patient rounds from other, similar telemedical services that can be facilitated virtually such as triage or intake consultations. While the World Health Organization (2020) provides a standardized definition of telemedicine, which does include telerounding, we posit that a separate definition of telerounding is needed in research based on the large variety of services that have been reported in studies and described similarly as telerounding.
We also recommend that telerounding researchers adopt standard conventions for reporting the systems that are used to facilitate telerounding in their studies. Researchers should denote whether the systems used in their design are robotic or non-robotic and provide more detail concerning the specifications of their telerounding systems, such as the specific robotic platform that was used and its manufacturer, or the specifications of the audio-visual hardware and software that are used to support non-robotic telerounding. If telerounding research reports information about the systems that are used to support telerounding more clearly, the likelihood of other researchers being forced to treat disparate systems as equivalent when evaluating telerounding studies is reduced.
We recommend that the telerounding domain attempt to standardize outcomes to the furthest extent possible in order to generate comparable effects across studies. Without consistent reporting standards, meta-analytic syntheses of literature cannot feasibly be conducted. For example, a trend of telerounding literature is including a measure of satisfaction of the patient and/or provider in using the telerounding technology, but there is rarely a validated satisfaction scale in use when measuring this construct. Patient or provider satisfaction represents only one facet of the many outcomes that suffer from this lack of consistency reported in this domain.