An after-action review for adoption of emerging technologies during the COVID-19 pandemic

IntroductionThe COVID-19 pandemic response has accelerated adoption of digital health technologies to support social distancing. In part, this involves repurposing technologies that were not originally developed for healthcare application. In the hospital setting, this includes the appropriation of ‘Off the Shelf’ (OTS) digital products that facilitate video-based clinical consultations, diagnostics and communication during ward rounds and multi-disciplinary team meetings. Such technologies were implemented within weeks at GOSH where video consultations were implemented for >90% of outpatient appointments.MethodsHere we present the findings from a Debrief-After Action Review (AAR) lasting two hours, supplemented with speculative questions on how lessons learned from the rapid deployment of one technology could inform the adoption practices of other emerging technologies.ResultsFifteen participants, who were members of a Transforming Care Links working group and interested in the impact of digital systems on patient care, contributed to the AAR. Five themes were identified from thematic analysis of this bottom-up approach: (i) Clinical: Planning and redesigning workflows with clear purpose, intent, and communication with clinical teams (ii) Technology: Infrastructure and equipment available across the team based on the needs of the workspace, with security and governance processes (iii) Capability mapping: Building core capability in a structured way across the entire team with space and time to trial out technologies as part of a progressive learning path and supported by clinical champions (iv) Benefits: Demonstrable benefits with new technology enabled ways of working based on preliminary small-scale deployments that deliver measurable value (v) Environment and Context: Context-specific workflow redesign for technology enabled interactions that consider optimum conditions of the physical environment.ConclusionThis user-centred approach identified routine training pathways, equity of access to training opportunities and equipment, a period of trialability and demonstrable benefits as enablers for the successful adoption of emerging technologies.

Clinical perception of effectiveness of virtual appointments and comparison with appointment outcomes at a specialist children's hospital.

INTRODUCTION: A transition from face-to-face to virtual consultations occurred in response to the COVID-19 pandemic. Evaluation of outcome data is essential for future healthcare modelling. METHODS: Clinicians at a children's hospital evaluated perceptions of face-to-face video and telephone appointments by questionnaire. Responses were compared with operational outcomes from June 2019 and June 2020. RESULTS: Ninety-three clinicians responded from 28 subspecialties. Virtual consultations increased from 6% (2019) to 67% (2020). No differences were found between appointment types for recording a medical and social history; a significant difference (p<0.001) was seen for the perceived ability to detect clinical signs, organise investigations and make a diagnosis. The proportion of appointments resulting in discharge compared with face-to-face visits was unchanged. The proportion of patients requiring further contact increased from 35% (32% face-to-face and 3% telephone) to 46% (14% face-to-face; 21% telephone and 11% video; chi-squared 426; p<0.0001).The percentage of patients offered an appointment following two 'was not brought' appointments increased from 71% (2019) to 81% (2020) and was most common following telephone appointments (20% face-to-face, 43% telephone and 18% video; chi-squared 474; p<0.0001). CONCLUSION: The perception of clinicians is that virtual appointments enabled continuity of paediatric care with improved clinical assessment capability and attendance during video consultations compared with telephone consultations.