title: Impact of telemedicine in hospital culture and its consequences on quality of care and safety.
abstract: OBJECTIVE
  To describe the impact of the telemedicine application on the clinical process of care and its different effects on hospital culture and healthcare practice.
  
  
  METHODS
  The concept of telemedicine through real time audio-visual coverage was implemented at two different hospitals in São Paulo: a secondary and public hospital, Hospital Municipal Dr. Moysés Deutsch, and a tertiary and private hospital, Hospital Israelita Albert Einstein.
  
  
  RESULTS
  Data were obtained from 257 teleconsultations records over a 12-month period and were compared to a similar period before telemedicine implementation. For 18 patients (7.1%) telemedicine consultation influenced in diagnosis conclusion, and for 239 patients (92.9%), the consultation contributed to clinical management. After telemedicine implementation, stroke thrombolysis protocol was applied in 11% of ischemic stroke patients. Telemedicine approach reduced the need to transfer the patient to another hospital in 25.9% regarding neurological evaluation. Sepsis protocol were adopted and lead to a 30.4% reduction mortality regarding severe sepsis.
  
  
  CONCLUSIONS
  The application is associated with differences in the use of health services: emergency transfers, mortality, implementation of protocols and patient management decisions, especially regarding thrombolysis. These results highlight the role of telemedicine as a vector for transformation of hospital culture impacting on the safety and quality of care.
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: Milton
authors.initials: M
authors.lastname: Steinman
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: Renata Albaladejo
authors.initials: RA
authors.lastname: Morbeck
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: Philippe Vieira
authors.initials: PV
authors.lastname: Pires
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: Carlos Alberto Cordeiro
authors.initials: CA
authors.lastname: Abreu Filho
authors.affiliation: Hospital Municipal Dr. Moysés Deutsch, São Paulo, SP, Brazil.
authors.forename: Ana Helena Vicente
authors.initials: AH
authors.lastname: Andrade
authors.affiliation: Sociedade Beneficente Israelita, São Paulo, SP, Brazil.
authors.forename: Jose Claudio Cyrineu
authors.initials: JC
authors.lastname: Terra
authors.affiliation: Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: José Carlos
authors.initials: JC
authors.lastname: Teixeira Junior
authors.affiliation: Sociedade Beneficente Israelita, São Paulo, SP, Brazil.
authors.forename: Alberto Hideki
authors.initials: AH
authors.lastname: Kanamura
mesh_terms: D000720:Ancillary Services, Hospital / Q000706:statistics & numerical data; D003422:Critical Care / Q000379:methods; D003695:Delivery of Health Care / Q000379:methods*; D004632:Emergency Medical Services / Q000379:methods; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D033181:Information Dissemination / Q000379:methods; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015279:Organizational Culture; D061214:Patient Safety; D011787:Quality of Health Care / Q000706:statistics & numerical data* / Q000639:trends; D017216:Telemedicine / Q000458:organization & administration / Q000706:statistics & numerical data