Provider Impressions of Inpatient Teleneurology Consultation

Abstract

Background and objectives: Teleneurology usage has increased during the severe acute respiratory syndrome coronavirus 2 pandemic. However, studies evaluating physician impressions of inpatient teleneurology are limited. We implemented a quality improvement initiative to evaluate neurologists' impression following individual inpatient teleneurology consultation at a satellite hospital of a large academic center with no in-person neurology coverage.

Methods: A REDCap survey link was embedded within templates used by neurologists for documentation of inpatient consultations to be completed immediately after encounters. All teleneurology encounters with completed surveys at a single satellite hospital of the University of Pennsylvania Health System Neurology Department between May 10, 2021, and August 14, 2022, were included. Individual patient-level and encounter-level data were extracted from the medical record.

Results: A total of 374 surveys (response rate of 54.05%) were completed by 19 neurologists; 341 questionnaires were included in the analysis. Seven neurologists who specialized as neurohospitalists completed 231 surveys (67.74% of total surveys completed), while 12 non-neurohospitalists completed 110 (32.36%). The history obtained was rated as worse (14%) or the same (86%) as an in-person consult; none reported the history as better than nonteleneurology encounters. The physician-patient relationship was poor or fair in 25% of the encounters and good or excellent in 75% of visits. The overall experience was judged to be worse than in-person consultation in 32% of encounters, the same in 66%, and better in 2%. Fifty-one percent of providers responded that there were elements of the neurologic examination that might have changed their assessment and plan of care if performed in-person. Encounters with peripheral or neuromuscular-related chief complaints had the most inadequate examinations and worse overall experiences, while the most positive impressions of these clinical experiences were observed among seizure-related chief complaints.

Discussion: Determining best practices for inpatient teleneurology should consider the patient chief complaint to use teleneurology in scenarios with the highest likelihood of a positive experience. Further efforts should be made to the patient experience and to improve the remote examination to enhance the applicability of teleneurology to the full spectrum of inpatient neurologic consultations.

Figure 1. Flowchart of the Provider Survey Entries Included

Flowchart illustrating the inpatient neurology consultations completed at the satellite hospital, the number of surveys completed by providers involved, and overview of the questionnaires included for analysis.

Figure 2. Summary of Provider Inpatient Teleneurology Clinical Impressions and Examination

Provider impressions evaluating clinical features of their inpatient teleneurology experience. (A) Summary of clinical impressions with the percent of providers responding to each question category illustrated in the colored, horizontal bars. (B) Provider impressions of the teleneurology examination. Data reported as N (%) of total cohort. Multiple selections were available.

Figure 3. Impressions of Examination and Overall Experience in Cohort

Summary of providers' assessments of the neurologic examination and overall inpatient teleneurology experience. Percent of (A) inadequate and adequate examination ratings and (C) worse and same or better compared across other clinical components assessed. Distribution of chief complaints resulting in neurologic consultation that had highest frequency and percentage of (B) inadequate neurologic examination and (D) worse overall experience compared with an in-person visit consultation. eTable 1 lists Other Consult Reason Categories.