Exploring differences in patient participation in simulated emergency cases in co-located and distributed rural emergency teams – an observational study with a randomized cross-over design

Abstract

<jats:title>Abstract</jats:title><jats:sec> <jats:title>Background</jats:title> <jats:p>In northern rural Sweden, telemedicine is used to improve access to healthcare and to provide patient-centered care. In emergency care during on-call hours, video-conference systems are used to connect the physicians to the rest of the team – creating ‘distributed teams’. Patient participation is a core competency for healthcare professionals. Knowledge about how distributed teamwork affects patient participation is missing.</jats:p> <jats:p>The aim was to investigate if and how teamwork affecting patient participation, as well as clinicians’ perceptions regarding shared decision-making differ between co-located and distributed emergency teams.</jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>In an observational study with a randomized cross-over design, healthcare professionals (<jats:italic>n</jats:italic> = 51) participated in authentic teams (<jats:italic>n</jats:italic> = 17) in two scripted simulated emergency scenarios with a standardized patient: one as a co-located team and the other as a distributed team. Team performances were filmed and observed by independent raters using the PIC-ET tool to rate patient participation behavior. The participants individually filled out the Dyadic OPTION questionnaire after the respective scenarios to measure perceptions of shared decision-making. Scores in both instruments were translated to percentage of a maximum score. The observational data between the two settings were compared using linear mixed-effects regression models and the self-reported questionnaire data were compared using one-way ANOVA. Neither the participants nor the observers were blinded to the allocations.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>A significant difference in observer rated overall patient participation behavior was found, mean 51.1 (± 11.5) % for the co-located teams vs 44.7 (± 8.6) % for the distributed teams (<jats:italic>p</jats:italic> = 0.02). In the PIC-ET tool category ‘Sharing power’, the scores decreased from 14.4 (± 12.4) % in the co-located teams to 2 (± 4.4) % in the distributed teams (<jats:italic>p</jats:italic> = 0.001). Co-located teams scored in mean 60.5% (± 14.4) when self-assessing shared decision-making, vs 55.8% (± 15.1) in the distributed teams (<jats:italic>p</jats:italic> = 0.03).</jats:p> </jats:sec><jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Team behavior enabling patient participation was found decreased in distributed teams, especially regarding sharing power with the patient. This finding was also mirrored in the self-assessments of the healthcare professionals. This study highlights the risk of an increased power asymmetry between patients and distributed emergency teams and can serve as a basis for further research, education, and quality improvement.</jats:p> </jats:sec>