Here is the standardised PICO analysis for the fifteenth uploaded article:
Full Title
Experiences of nurses working in RACFs and EDs utilising visual telehealth consultation to assess the need for RACF resident transfer to ED: A qualitative descriptive study
Authors: Carla Sunner, Michelle Therese Giles, Ashley Kable, Maralyn Foureur
Journal: Journal of Clinical Nursing, 2023; 32(15–16): 4694–4709
DOI: 10.1111/jocn.16529
Type of Study
Qualitative descriptive study using focus groups (part of the broader PACE-IT project)
PICO Summary
Population (P)
- Nurses working in Residential Aged Care Facilities (RACFs) and Emergency Departments (EDs) in New South Wales, Australia
- Participants had used visual telehealth consultation (VTC) as part of the PACE-IT Model of Care
- Total: 6 focus groups (4 RACF groups, 2 ED groups); participants varied in experience, roles, and rural/metropolitan settings
Intervention (I)
- Use of visual telehealth consultation (VTC) integrated into an existing nurse-led outreach model (Aged Care Emergency or ACE service)
- Enabled real-time visual assessments of RACF residents via platforms like Scopia, involving ED nurses, RACF nurses, residents, and family
- Aim: to support decision-making about whether a resident needed transfer to ED
Comparison (C)
- Implicit comparator: standard practice using telephone-only consultation (ACE service without vision)
Outcomes (O)
Person-centred outcomes:
- VTC enhanced inclusion of residents and families in decision-making
- Improved resident safety by avoiding unnecessary transfers for vulnerable patients (e.g., dementia)
Process outcomes:
- Built trust, confidence, and relationships between ED and RACF nurses
- Improved communication clarity and assessment accuracy compared to telephone-only consults
- Supported education and skill development for less experienced RACF nurses
- Challenges noted:
- Technological barriers: poor Wi-Fi, device confusion, limited volume for hearing-impaired residents
- Time burden: VTC sometimes perceived as time-consuming
- GP availability: poor GP engagement impeded shared decision-making
- Inconsistent ISBAR handovers
Health system outcomes (inferred):
- Improved triage accuracy and preparation for residents arriving in ED
- Potential reduction in inappropriate ED transfers, though not quantitatively assessed in this paper
Findings Summary
The study found that visual telehealth significantly improved decision-making, resident-centred care, and collaborative relationships between RACF and ED nurses. VTC enabled enhanced communication, especially through visual confirmation of symptoms, leading to more appropriate triage decisions. RACF nurses, particularly junior staff, reported increased confidence and skill development. However, technological limitations (connectivity, access to equipment, staff digital literacy) were significant barriers to sustainability. The study supports further infrastructure investment and integration of VTC into routine care models in aged care .
Life In The Slower Lane 
Leave a comment