(Image source: https://www.linkedin.com/pulse/concept-environmental-scanning-risk-identification-khan/)
An environmental scan may inform strategic planning and decision making for projects or interventions, guide the direction of a new public health activity, raise awareness of health disparities or other inequities, or initiate a project or funding opportunity (Wilburn et al., 2016). The following environmental scan was found, which assesses the implementation of Telestroke in Canada:
This report identified 15 organizations, two of which are in Canada, that provide telestroke services. The environmental scan utilized the information collected in a systematic review, as well as a Google search, which resulted in 400 articles found. The objective of the environmental scan was to identify and assess organizations that provide acute telestroke services of relevance to Canadian policy makers. The three focuses of the environmental scan were i) staffing issues ii) volume of patients, and iii) coverage area.
The systematic review and environmental scan addressed the following questions regarding the use of telehealth in the delivery of acute stroke care
What evidence exists in the peer-reviewed literature to support the use of telestroke in the improvement of health outcomes?
Does the use of telestroke improve access to health services?
Does telestroke affect health care resource utilization?
What is the level of user satisfaction regarding health services delivered through telestroke?
What organizations and best practices are at the forefront of telestroke delivery?
The environmental scan identified that most telestroke services surveyed have a multidisciplinary team composed of licensed physicians (neurologists and neurosurgeons, fellows, residents), nurse practitioners and registered nurses, information technology experts, program coordinators, and managers. When identifying the number of patients each of the organizations treated with Telestroke, the scan proved that due to differences in inclusion criteria, it was difficult to compare data between sites. An example of this was that the Massachusetts General Hospital counts the number of stroke patients seen via telehealth, regardless of the number of videoconference encounters undertaken for a given patient, while the Ontario Telemedicine Network records encounters as the number of events undertaken to support non-scheduled emergency stroke consultations and the number of events where tPA is administered. The environmental scan also identified differences in how telestroke is utilized to treat patients. While the Ontario Telemedicine Network did not require the transportation of patients for tPA treatment, the Massachusetts General Hospital utilized air ambulance services. Based on the data collected, it was determined that more standardization is required to properly measure the nature and quantity of resources (e.g., staff, technology, funding) needed to support the telestroke program. Due to the differences in information available, it is difficult to compare programs, which would also lead to difficulty for new organizations to determine which practices to implement to ensure success. The environmental scan suggests that since more than half of the organizations that have developed telestroke programs are located in North America, there is opportunity for a collaborative approach to fill the gaps in knowledge, specifically those related to the safety of the interventions, the standardization of outcome measures, and the optimization of human and financial resources associated with telestroke care.
Reference
Canadian Agency for Drugs and Technologies in Health. (2008). Telehealth for Acute Stroke Management (Telestroke): Systematic Review of Analytic Studies and Environmental Scan of Relevant Initiatives. Technology Report, (99). https://www.cadth.ca/sites/default/files/pdf/456_Telestroke_tr_e.pdf
Khan, M. S. (2019, January 7). Concept of environmental scanning in risk identification. LinkedIn. https://www.linkedin.com/pulse/concept-environmental-scanning-risk-identification-khan/
Wilburn, A., Vanderpool, R. C., & Knight, J. R. (2016). Environmental scanning as a public health tool: Kentucky’s Human Papillomavirus Vaccination Project. Preventing Chronic Disease, 13, 1–6. https://doi.org/10.5888/pcd13.160165
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