Case study questions

13-1 Obstetrics is one of the most litigious specialties in health care. Healthcare professionals who work in Labor and Delivery (L&D) units are encouraged to maintain competency in fetal monitoring through continuing education and certification. Commonly, nurses in L&D units will provide bedside care for the laboring client, while the physician or midwife may attend to other tasks, such as in the office or operating room, until delivery is closer. This commonly used care delivery model for the laboring client necessitates clear and concise communication between the L&D nurses and the primary care provider to ensure quality and safe care for both mother and baby. Jessica is the unit manager of an L&D unit in a small rural hospital. All obstetrical services are provided to this community by one obstetrician who has a very busy solo practice. It is common for the obstetrician to have a full day of scheduled primary care in the office while a client labors in the hospital. The L&D nurses have recently expressed concern to Jessica about the delay in physician response regarding analysis of fetal monitor strips. The L&D nurses would like to have a quicker response from the physician when there is a pattern of concern on the monitor strip. In cases of obvious fetal distress and other obstetrical emergencies, the nurses felt justified in asking for the obstetrician’s rapid presence on the unit. In cases of fetal monitoring strips demonstrating equivocal patterns, the nurses needed to collaborate and communicate quickly with the obstetrician for review of the strip and planning for immediate patient care. The L&D nurses were seeking resolution to this concern. After much review of the literature and discussions with a colleague in a large teaching hospital, Jessica learned about AirStrip One, an innovative technology that allows care providers to collaborate in near real-time analysis of the fetal monitor strip interpretations despite geographic boundaries. Other data points, such as elements of the electronic health record, labs, and hemodynamics may transmit in tandem with the fetal monitor strip. The obstetrician can use a smartphone or tablet remotely to access a laboring client’s fetal monitor strip. In talking with AirStrip One’s developers, Jessica found that the telehealth product could meet the needs of the L&D unit, easily integrating with the existing fetal monitoring system to provide a high-quality, HIPAA-protected platform for data sharing and professional engagement among healthcare providers. After much collaboration with the company in reviewing the product’s white papers and specifications, Jessica approached the obstetrician and L&D nurses who were relieved to learn of this technology. After purchase of the telehealth technology, a policy for its use was drafted, and L&D nurses were trained in use of the product. Now, when a pregnant woman presents to the L&D unit, the nurses confidently initiate the obstetrical telehealth algorithm. The client’s menstrual, sexual, and pregnancy history and vital signs are collected, the fetal monitor is applied, and AirStrip One is utilized to transmit the near real-time fetal monitor strip and medical data to be analyzed by the primary care provider as needed. The obstetrician continues to respond to immediate calls of distress, and the nurses continue to communicate throughout the course of labor with the reassurance that all parties have access to the same client data.   Check Your Understanding

1. Besides the L&D unit manager, which other stakeholders should have been involved in the

discussion of telehealth to create a solution for this unit’s concerns? Why?

2. How could the use of telehealth, as outlined in this case study, enhance unit morale and client

outcomes?

3. How could telehealth, as utilized in this case study, decrease the risk of liability for the healthcare providers?

14-1 Amanda is a 42-year-old female diagnosed with type 2 diabetes. She feels that it was only a matter of time before she was diagnosed because her mother and sisters all have diabetes. Amanda is 40 pounds overweight and knows that she needs to control her weight to help with better control of her “sugar.” A friend of hers suggested using a health app targeted to help those with diabetes. Amanda is skeptical but knows that she has to do something and not “end up on insulin shots.” Amanda’s friend shows her how to download the free app from the app store on her smartphone. Amanda is excited that the app can track her glucose levels by synching with her glucometer. She can even manually upload the glucose readings if she wishes. The app will display critical state messages if her glucose goes above a certain reading. The app uses the same criteria as the American Diabetes Association for glucose readings. The app can integrate data from her fitness tracker; blood pressure, hemoglobin A1c levels, and weight. This gives Amanda a clear picture of what is going on with her health and she can share this data with her nurse practitioner during her visits. To her surprise, Amanda also receives coaching messages from her app that encourage her to be more active and count the amount of fluid and vegetable intake for the day. Amanda is excited about the feedback she is receiving from her app and feels that this makes her accountable for actions related to her health. After a month of using the app, Amanda has lost 5 pounds and is more active.   Check Your Understanding

1. Does Amanda need to be supervised by an HCP to use mHealth apps?
2. Does Amanda need to be concerned about her health data on the smartphone?
3. Would the U.S. Food and Drug Administration (FDA) be interested in regulating the mHealth

apps that Amanda used?      

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