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Leonny S, Bowra J, Davis RA, Zuleta N, Hansen K, Large R, Yeung J. Review article: Telehealth in Emergency Medicine in Australasia: Advantages and barriers. Emerg Med Australas 2024. [PMID: 38649791 DOI: 10.1111/1742-6723.14411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/15/2024] [Accepted: 03/29/2024] [Indexed: 04/25/2024]
Abstract
The COVID-19 pandemic catapulted Telehealth to the forefront of Emergency Medicine (EM) as an alternative way of assessing and managing patients. This challenged the traditional idea that EM can only be practised within brick-and-mortar EDs. Many Emergency Physicians may find the idea of practising Telehealth in Emergency Medicine (TEM) confronting, particularly in the absence of training and clear practice guidelines. The purpose of the present paper is to describe the current use of TEM in Australasia, and outline the advantages and barriers in adopting this practice domain.
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Affiliation(s)
- Sheravika Leonny
- My Emergency Doctor, Sydney, New South Wales, Australia
- Peninsula Health, Melbourne, Victoria, Australia
| | - Justin Bowra
- My Emergency Doctor, Sydney, New South Wales, Australia
- Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Rebecca A Davis
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- RPA Virtual Hospital, Sydney, New South Wales, Australia
| | - Natalia Zuleta
- WA Country Health Service, Perth, Western Australia, Australia
| | - Kim Hansen
- Virtual Emergency Department, Metro North, Brisbane, Queensland, Australia
- Critical Care, Women's and Children's Service Line, Redcliffe Hospital, Redcliffe, Queensland, Australia
| | - Ruth Large
- New Zealand Telehealth Leadership Group, Christchurch, New Zealand
- Whakarongorau Aotearoa//New Zealand Telehealth Services, Auckland, New Zealand
| | - Justin Yeung
- WA Country Health Service, Perth, Western Australia, Australia
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Turner J, Clarke M, George G, Jones RW, Pullinger R, Kharbanda R, Kennedy J, Hands L. Video-consultation in the Emergency Department: An Assessment of the Potential Benefit for a UK District General Hospital (Preprint). Interact J Med Res 2021; 11:e36081. [PMID: 36107488 PMCID: PMC9523531 DOI: 10.2196/36081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/15/2022] [Accepted: 03/29/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jane Turner
- Nuffield Department of Surgical Science, University of Oxford, Oxford, United Kingdom
| | - Malcolm Clarke
- Department of Electronic Engineering, Maynooth International Engineering College, Fuzhou, China
| | - Grizelda George
- Oxford University Hospitals National Health Service Foundation Trust, Oxford, United Kingdom
| | | | - Rick Pullinger
- Oxford University Hospitals National Health Service Foundation Trust, Oxford, United Kingdom
| | - Rajesh Kharbanda
- Oxford University Hospitals National Health Service Foundation Trust, Oxford, United Kingdom
| | - James Kennedy
- Oxford University Hospitals National Health Service Foundation Trust, Oxford, United Kingdom
| | - Linda Hands
- Nuffield Department of Surgical Science, University of Oxford, Oxford, United Kingdom
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Pappalardo M, Fanelli U, Chiné V, Neglia C, Gramegna A, Argentiero A, Esposito S. Telemedicine in Pediatric Infectious Diseases. CHILDREN-BASEL 2021; 8:children8040260. [PMID: 33800549 PMCID: PMC8066295 DOI: 10.3390/children8040260] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/24/2021] [Accepted: 03/25/2021] [Indexed: 11/18/2022]
Abstract
Telemedicine is the remote practice of medicine through the use of information and communication technologies for the prevention, diagnosis, treatment and management of diseases. In this narrative review, we illustrate how telemedicine technologies are increasingly integrated into pediatric infectious disease programs with the aim of facilitating access to specialist care and reducing costs. There is widespread use of telemedicine for the management of acute and chronic infectious diseases, particularly in countries in which the majority of the population lives in rural areas, far from third-level hospital centers located in large urban centers. Obviously, telemedicine is also used in developed countries, and its importance has been further increased recently given the COVID-19 pandemic. It has many advantages for patients, such as saving time, money and working hours, and reducing cancelled appointments and delays, while there are also many advantages for doctors, allowing collaborations with specialists and continuous updating. Among the disadvantages are the limitation in carrying out an objective examination, which is particularly important for children under 2 years of age, and the need for cutting-edge technology and reliable connectivity. Telemedicine increasingly represents the future and the beginning of a new healthcare system that also will redefine medical care for the treatment of infectious diseases, both acute and chronic. However, the majority of the experience has involved adults, and its validation in pediatric care, as well as its application in real-life practices, are urgently needed.
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Affiliation(s)
- Marco Pappalardo
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (M.P.); (U.F.); (V.C.); (C.N.); (A.A.)
| | - Umberto Fanelli
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (M.P.); (U.F.); (V.C.); (C.N.); (A.A.)
| | - Vincenzo Chiné
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (M.P.); (U.F.); (V.C.); (C.N.); (A.A.)
| | - Cosimo Neglia
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (M.P.); (U.F.); (V.C.); (C.N.); (A.A.)
| | - Andrea Gramegna
- Respiratory Unit and Cystic Fibrosis Adult Center, Internal Medicine Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Alberto Argentiero
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (M.P.); (U.F.); (V.C.); (C.N.); (A.A.)
| | - Susanna Esposito
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (M.P.); (U.F.); (V.C.); (C.N.); (A.A.)
- Correspondence: ; Tel.: +39-0521-704790
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Chou E, Hsieh YL, Wolfshohl J, Green F, Bhakta T. Onsite telemedicine strategy for coronavirus (COVID-19) screening to limit exposure in ED. Emerg Med J 2020; 37:335-337. [PMID: 32366616 DOI: 10.1136/emermed-2020-209645] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 04/16/2020] [Accepted: 04/24/2020] [Indexed: 11/04/2022]
Abstract
Coronavirus (severe acute respiratory syndrome coronavirus 2) outbreak is a public health emergency and a global pandemic. During the present coronavirus disease (COVID-19) crisis, telemedicine has been recommended to screen suspected patients to limit risk of exposure and maximise medical staff protection. We constructed the protective physical barrier with telemedicine technology to limit COVID-19 exposure in ED. Our hospital is an urban community hospital with annual ED volume of approximately 50 000 patients. We equipped our patient exam room with intercom and iPad for telecommunication. Based on our telemedicine screening protocol, physician can conduct a visual physical examination on stable patients via intercom or videoconference. Telemedicine was initially used to overcome the physical barrier between patients and physicians. However, our protocol is designed to create a protective physical barrier to protect healthcare workers and enhance efficiency in ED. The implementation can be a promising protocol in making ED care more cost-effective and efficient during the COVID-19 pandemic and beyond.
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Affiliation(s)
- Eric Chou
- Department of Emergency Medicine, Baylor Scott and White All Saints Medical Center Fort Worth, Fort Worth, Texas, USA
| | - Yu-Lin Hsieh
- Department of Emergency Medicine, Baylor Scott and White All Saints Medical Center Fort Worth, Fort Worth, Texas, USA
| | - Jon Wolfshohl
- Department of Emergency Medicine, Baylor Scott and White All Saints Medical Center Fort Worth, Fort Worth, Texas, USA
| | - Fonda Green
- Department of Emergency Medicine, Baylor Scott and White All Saints Medical Center Fort Worth, Fort Worth, Texas, USA
| | - Toral Bhakta
- Department of Emergency Medicine, Baylor Scott and White All Saints Medical Center Fort Worth, Fort Worth, Texas, USA
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Abstract
Ultrasound is an efficacious, versatile and affordable imaging technique in emergencies, but has limited utility without expert interpretation. Telesonography, in which experts may remotely support the use of ultrasound through a telecommunications link, may broaden access to ultrasound and improve patient outcomes, particularly in remote settings. This review assesses the literature regarding telesonography in emergency medicine, focussing on evidence of feasibility, diagnostic accuracy and clinical utility. A systematic search was performed for articles published from 1946 to February 2017 using the Cochrane, Medline, EMBASE, and CINAHL databases. Further searches utilising Scopus, Google Scholar, and citation lists were conducted. 4388 titles were identified and screened against inclusion criteria which resulted in the inclusion of 28 papers. These included feasibility, diagnostic accuracy and clinical pilot studies. Study design, methodology and quality were heterogeneous. There was good evidence of feasibility from multiple studies. Where sufficient bandwidth and high quality components were used, diagnostic accuracy was slightly reduced by image transmission. There was evidence of clinical utility in remote hospitals and low-resource settings, although reliability was infrequently reported. Further exploratory research is required to determine minimum requirements for image quality, bandwidth, frame rate and to assess diagnostic accuracy. Clinical trials in remote settings are justifiable. Telecommunication options will depend on local requirements; no one system conveys universal advantages. The methodological quality of research in this field must improve: studies should be designed to minimise bias, and must include details of their methods to allow replication. Analysis of cost effectiveness and sustainability should be provided.
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Affiliation(s)
| | - Leila Eadie
- Centre for Rural Health, University of Aberdeen, Inverness, Scotland, United Kingdom
| | - Philip Wilson
- Centre for Rural Health, University of Aberdeen, Inverness, Scotland, United Kingdom
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Woldaregay AZ, Walderhaug S, Hartvigsen G. Telemedicine Services for the Arctic: A Systematic Review. JMIR Med Inform 2017; 5:e16. [PMID: 28659257 PMCID: PMC5508113 DOI: 10.2196/medinform.6323] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 10/07/2016] [Accepted: 04/04/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Telemedicine services have been successfully used in areas where there are adequate infrastructures such as reliable power and communication lines. However, despite the increasing number of merchants and seafarers, maritime and Arctic telemedicine have had limited success. This might be linked with various factors such as lack of good infrastructure, lack of trained onboard personnel, lack of Arctic-enhanced telemedicine equipment, extreme weather conditions, remoteness, and other geographical challenges. OBJECTIVE The purpose of this review was to assess and analyze the current status of telemedicine services in the context of maritime conditions, extreme weather (ie, Arctic weather), and remote accidents and emergencies. Moreover, the paper aimed to identify successfully implemented telemedicine services in the Arctic region and in maritime settings and remote emergency situations and present state of the art systems for these areas. Finally, we identified the status quo of telemedicine services in the context of search and rescue (SAR) scenarios in these extreme conditions. METHODS A rigorous literature search was conducted between September 7 and October 28, 2015, through various online databases. Peer reviewed journals and articles were considered. Relevant articles were first identified by reviewing the title, keywords, and abstract for a preliminary filter with our selection criteria, and then we reviewed full-text articles that seemed relevant. Information from the selected literature was extracted based on some predefined categories, which were defined based on previous research and further elaborated upon via iterative brainstorming. RESULTS The initial hits were vetted using the title, abstract, and keywords, and we retrieved a total of 471 papers. After removing duplicates from the list, 422 records remained. Then, we did an independent assessment of the articles and screening based on the inclusion and exclusion criteria, which eliminated another 219 papers, leaving 203 relevant papers. After a full-text assessment, 36 articles were left, which were critically analyzed. The inter-rater agreement was measured using Cohen Kappa test, and disagreements were resolved through discussion. CONCLUSIONS Despite the increasing number of fishermen and other seafarers, Arctic and maritime working conditions are mainly characterized by an absence of access to health care facilities. The condition is further aggravated for fishermen and seafarers who are working in the Arctic regions. In spite of the existing barriers and challenges, some telemedicine services have recently been successfully delivered in these areas. These services include teleconsultation (9/37, 24%), teleradiology (8/37, 22%), teledermatology and tele-education (3/37, 8%), telemonitoring and telecardiology (telesonography) (1/37, 3%), and others (10/37, 27%). However, the use of telemedicine in relation to search and rescue (SAR) services is not yet fully exploited. Therefore, we foresee that these implemented and evaluated telemedicine services will serve as underlying models for the successful implementation of future search and rescue (SAR) services.
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Affiliation(s)
| | - Ståle Walderhaug
- Department of Computer Science, University of Tromsø - The Arctic University of Norway, Tromsø, Norway.,SINTEF Digital, Software Engineering, Safety and Security, Tromsø, Norway
| | - Gunnar Hartvigsen
- Department of Computer Science, University of Tromsø - The Arctic University of Norway, Tromsø, Norway.,Norwegian Centre for e-Health Research, University Hospital of North Norway, Tromsø, Norway
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Abstract
Telemedicine applications have been rapidly implemented since the early 1990s and are now in use in a wide range of healthcare settings. There is, however, limited evidence of clinical benefits resulting from their use. This paper describes the design and implementation of a multi-method evaluation of an emergency telemedicine application's clinical impact. In particular, the challenges faced and lessons learnt regarding the development of a suitable methodology and collection of health information from a variety of sources are discussed. In order to understand the application's clinical impact it was necessary to use different types of data from multiple sources, and to interpret the results from each enquiry in relation to results from the others.
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Sibson L. The use of telemedicine technology to support in pre-hospital patient care. ACTA ACUST UNITED AC 2014. [DOI: 10.12968/jpar.2014.6.7.344] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Lynda Sibson
- independent nusres consultant; lecturer, FD Paramedic Studies, Coventry University; telemedicine project manager, Addenbrooke's Hospital, Cambridge
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Hasselberg M, Beer N, Blom L, Wallis LA, Laflamme L. Image-based medical expert teleconsultation in acute care of injuries. A systematic review of effects on information accuracy, diagnostic validity, clinical outcome, and user satisfaction. PLoS One 2014; 9:e98539. [PMID: 24887257 PMCID: PMC4041890 DOI: 10.1371/journal.pone.0098539] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 05/05/2014] [Indexed: 11/19/2022] Open
Abstract
Objective To systematically review the literature on image-based telemedicine for medical expert consultation in acute care of injuries, considering system, user, and clinical aspects. Design Systematic review of peer-reviewed journal articles. Data sources Searches of five databases and in eligible articles, relevant reviews, and specialized peer-reviewed journals. Eligibility criteria Studies were included that covered teleconsultation systems based on image capture and transfer with the objective of seeking medical expertise for the diagnostic and treatment of acute injury care and that presented the evaluation of one or several aspects of the system based on empirical data. Studies of systems not under routine practice or including real-time interactive video conferencing were excluded. Method The procedures used in this review followed the PRISMA Statement. Predefined criteria were used for the assessment of the risk of bias. The DeLone and McLean Information System Success Model was used as a framework to synthesise the results according to system quality, user satisfaction, information quality and net benefits. All data extractions were done by at least two reviewers independently. Results Out of 331 articles, 24 were found eligible. Diagnostic validity and management outcomes were often studied; fewer studies focused on system quality and user satisfaction. Most systems were evaluated at a feasibility stage or during small-scale pilot testing. Although the results of the evaluations were generally positive, biases in the methodology of evaluation were concerning selection, performance and exclusion. Gold standards and statistical tests were not always used when assessing diagnostic validity and patient management. Conclusions Image-based telemedicine systems for injury emergency care tend to support valid diagnosis and influence patient management. The evidence relates to a few clinical fields, and has substantial methodological shortcomings. As in the case of telemedicine in general, user and system quality aspects are poorly documented, both of which affect scale up of such programs.
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Affiliation(s)
- Marie Hasselberg
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Netta Beer
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Lisa Blom
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Lee A. Wallis
- Division of Emergency Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- * E-mail:
| | - Lucie Laflamme
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- University of South Africa, Pretoria, South Africa
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Ajami S, Arzani-Birgani A. Fast resuscitation and care of the burn patients by telemedicine: A review. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2014; 19:562-6. [PMID: 25197300 PMCID: PMC4155713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 11/12/2013] [Accepted: 11/22/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND In Iran, burns are the second most common cause of death, after traffic accidents in individuals under the age of 15 years. Many burned patients die or suffer injury due to lack of immediate care, so we need to use an alternative resuscitations to cure them immediately. Telemedicine describes the use of medical information exchanged from one site to another via electronic communications to improve patients' health status and care. The aim of this study was to express the advantages of Telemedicine to resuscitate and care burn patients. MATERIALS AND METHODS This study was a narrative review. The literature was searched on fast resuscitation and care of the patients' burn by telemedicine with the help of libraries, databases, and also searches engines available at Google, Google scholar, books and conference proceedings. In our searches, we employed the following keywords and their combinations: Telemedicine, Telecare, Burn, Burn patient, Air transport, Triage and Health Information Management in the searching areas of titles, keywords, abstracts and full texts. RESULTS In this study, more than 78 articles and reports were collected and 30 of them were selected based on their relevancy. CONCLUSION Acute evaluation of burn patients can be performed by the telemedicine and it plays an important role in improving access to the required expertise, and raises physician confidence in treating burn patients. This can reduce under-triage or over-triage for air transport and finally lead to saving time and cost.
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Affiliation(s)
- Sima Ajami
- Health Information Technology and Management Department, Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Arezo Arzani-Birgani
- Health Information Technology, School of Medical Management and Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
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Johnsen E, Bolle SR. To see or not to see--better dispatcher-assisted CPR with video-calls? A qualitative study based on simulated trials. Resuscitation 2008; 78:320-6. [PMID: 18583015 DOI: 10.1016/j.resuscitation.2008.04.024] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2008] [Revised: 03/11/2008] [Accepted: 04/10/2008] [Indexed: 12/20/2022]
Abstract
BACKGROUND Video communication through mobile telephone is now available in many parts of the world. We ask how mobile phone video-calls compares with traditional phone calls for dispatcher-assisted cardiopulmonary resuscitation (T-CPR). METHODS Primary data was collected through individual interviews with six dispatchers after their participation in simulated cardiac arrest. They had 10 scenarios each, during which they guided rescuers on resuscitation. During half of the scenarios they used video-calls, and traditional phone calls for the rest. Concepts from modern systems theory were used to analyse the material. RESULTS Video-calls influenced the information basis and understanding of the dispatchers. The dispatchers experienced that (1) video-calls are useful for obtaining information and provides adequate functionality to support CPR assistance; (2) their CPR assistance becomes easier; (3) the CPR might be of better quality; but (4) there is a risk of "noise". DISCUSSION We emphasize visual observation as a way of constructing professional understanding when using video-calls, which may provide a new basis for dispatcher assistance. Video-calls may improve rescuer compliance. The role and content of telephone-directed protocols used by dispatchers may need adjustments when video-calls are used for medical emergencies. CONCLUSION Video communication can improve the dispatchers' understanding of the rescuer's situation, and the assistance they provide.
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Affiliation(s)
- Elin Johnsen
- Norwegian Centre for Telemedicine (NST), University Hospital North Norway (UNN), p.b. 35, N-9038 Tromsø, Norway.
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Tsai SH, Kraus J, Wu HR, Chen WL, Chiang MF, Lu LH, Chang CE, Chiu WT. The effectiveness of video-telemedicine for screening of patients requesting emergency air medical transport (EAMT). ACTA ACUST UNITED AC 2007; 62:504-11. [PMID: 17297342 DOI: 10.1097/01.ta.0000219285.08974.45] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Demand for emergency air medical transport (EAMT) services have increased in recent years. However, the high costs of these services have raised questions on the benefit to patient outcomes. In this study, we evaluate the effectiveness of video-telemedicine for the preflight screening of patients for air medical transports. METHOD A prospective cohort study. Medical records of patients transported from the Penghu Islands to Taiwan were retrospectively collected from November 1999 to October 2002 (stage 1). In addition, we collected medical records of patients who were preflight-screened by physicians using video Web cameras from November 1, 2002 through August 30, 2003 (stage 2). The intervention in stage 2 included a set of protocols and screening criteria for EAMT implemented by the National Aeromedical Consultation Center (NACC). In stage 1, there were no standardized protocols or screening guidelines for EAMT. The EAMT system before implementing preflight screening and telemedicine was mostly based on patient's requests and their health condition determined by the treating medical officers (TMO). RESULTS A total of 822 transfers were included in this study. Patient demographic backgrounds in the two groups were similar on gender, age, disease classification, and types of illnesses. Patients in stage 2 were significantly older than those in stage 1. In a comparison of flight frequencies between the two stages, the results revealed a 36.2% reduction of EAMT applications in stage 2. The flight approval rate was 91.2%. The intervention in stage 2 also presented a significant reduction in cross-zone transport (16.1% to 0.1% to the northern Taiwan region). Within-zone transfers increased from 74.9% to 88.3%. Cost analysis showed that physician triage in stage 2 resulted in a total annual savings on EAMTs of US 448,986 dollars. CONCLUSIONS This study demonstrates the physician-assisted preflight screening using video-telemedicine significantly reduced the frequency of unnecessary air medical transports and consequently led to reduced costs. Video-telemedicine can be an essential tool to support physicians in decision-making for patient screening.
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Affiliation(s)
- Shin-Han Tsai
- Institute of Injury Prevention and Control, Department of Neurological Surgery, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan.
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Willis BH, Sur SD. How good are emergency department Senior House Officers at interpreting X-rays following radiographers?? triage? Eur J Emerg Med 2007; 14:6-13. [PMID: 17198320 DOI: 10.1097/01.mej.0000224438.74493.fa] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the accuracy of Senior House Officers at interpreting plain X-rays following their triage by radiographers in an emergency department. METHOD We collected 2593 patients' records by systematic sampling of all those seen by emergency physicians between January 2002 and April 2002 (ca 10 000 patients) in a UK emergency department. The variables recorded included evidence of X-ray investigations and, when present, the Senior House Officer's diagnosis, the presence (abnormal) or absence of a radiographers red dot and the reference standard diagnosis. A separate category of uncertain (inconclusive) was applied to the Senior House Officer and reference standard diagnosis where appropriate. Diagnostic performance was measured by likelihood ratios with associated pre-test and post-test probabilities. RESULTS Including the uncertain category as abnormal gave the following results: there were 967 X-rays and those with a red dot had a probability of an abnormality of 80%. Although a further opinion of abnormal by a Senior House Officer increased this probability to 89% when they overrode the red dot opinion of the radiographer, it was incorrect in 26% of cases. CONCLUSION Currently, the Senior House Officer contributes to the red dot system by improving on the radiographer in rates of diagnosis of both abnormal and normal X-rays. Further reductions in error rates, however, are unlikely to be achieved until there is a change to the existing system. This may ultimately involve removing some of the responsibility of X-ray interpretation from the Senior House Officer. Any future research should consider the methodological issues highlighted by this study.
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Affiliation(s)
- Brian H Willis
- Emergency Department, Horton Hospital, Oxford Radcliffe Hospitals NHS Trust, Oxon, UK.
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Tangtrakulwanich B, Kwunpiroj W, Chongsuvivatwong V, Geater AF, Kiatsiriroj N. Teleconsultation with digital camera images is useful for fracture care. Clin Orthop Relat Res 2006; 449:308-12. [PMID: 16691138 DOI: 10.1097/01.blo.0000218737.31129.6c] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
UNLABELLED Teleconsultation using digital camera images has not yet been proven useful in orthopaedic practice. We ascertained the validity and reliability of teleconsultation using digital camera images of 100 patients with nondisplaced or minimally displaced fractures and 50 healthy age-matched subjects. We used three sets of images from each patient: a digitized radiograph, digital clinical photographs of the injured site, and conventional analog radiographs. Assessments were made independently by three groups of assessors: four orthopaedic staff members, four senior residents, and four junior residents all of whom evaluated the digitized information via E-mail. Digitized radiographs, digitized radiographs supplemented with a clinical photograph, and conventional radiographs were assessed consecutively at 1-week intervals. We used clinical and radiographic followup data as a gold standard. The overall reliability (kappa), sensitivity, and specificity of digitized radiographs were 0.57, 83.2%, and 80.7%, respectively. Reliability, sensitivity, and specificity of the digitized radiographs were not decreased after transmitting via E-mail. The level of experience in radiographic interpretation was associated independently with fracture misdiagnosis. Teleconsultation using digital camera images was valid and reliable. We recommend sending clinical photographs with the digitized radiograph. LEVEL OF EVIDENCE Diagnostic study, level II. See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Boonsin Tangtrakulwanich
- Department of Orthopaedic Surgery and Physical Medicine, Prince of Songkla University, Songkhla, Thailand.
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Lindberg I, Christensson K, Ohrling K. Midwives’ experience of organisational and professional change. Midwifery 2005; 21:355-64. [PMID: 16023772 DOI: 10.1016/j.midw.2005.02.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2004] [Revised: 01/25/2005] [Accepted: 02/09/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE to describe midwives' experiences of changes in their caring role and professional function in postpartum wards in the northern part of Sweden. In this part of the country, three out of eight maternity departments have been closed over the last 5 years. During the same period, hospital stays have reduced in length, and an early discharge model has been introduced. DESIGN focus-group discussions. SETTING four focus groups at two hospitals in northern Sweden. PARTICIPANTS 21 midwives experienced in midwifery practice in maternity wards. FINDINGS the analysis revealed four categories of comments: 'to have limited time when caring for the mother and the baby'; 'no longer being valued as the expert'; 'a wish to have responsibility for childbirth in its entirety'; 'to see future possibilities in the development of the profession'. The theme identified is 'being ahead in ideas about caring but still partly caught up in the past'. KEY CONCLUSIONS AND IMPLICATIONS the identified theme of being ahead in ideas about caring but still partly caught up in the past can be understood as representing a transition. The midwives experienced loss and grief over their former midwifery practice, but had ideas and visions for developing and expanding their future professional role. A healthy transition requires support, participation and skilled management.
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Affiliation(s)
- Inger Lindberg
- Division of Nursing, Department of Health Science, Luleå University of Technology, Hedenbrovägen, SE 961 36 Boden, Sweden.
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16
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Abstract
A cost-consequences analysis of minor injuries telemedicine was performed alongside a randomized controlled trial in a UK peripheral emergency department. The main outcome measures were safety and clinical effectiveness at seven days after presentation. Costs to the National Health Service (NHS) and patients and their families, for 253 patients, were estimated for seven days following randomization. The mean cost to the NHS for the telemedicine patients was 78.61 pounds and for those assessed routinely was 39.15 pounds. For costs incurred by patients and their families the respective figures were 58.24 pounds and 43.95 pounds. Sensitivity analysis showed the initial results to be robust. Telemedicine was a more expensive option for providing minor injuries care in a general-practitioner-supported peripheral emergency department, while consequences did not vary greatly between the different options.
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Affiliation(s)
- Sian M Noble
- Department of Social Medicine, University of Bristol, Bristol, UK.
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17
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Hazebroucq V, Fery-Lemonnier E. [The value of teleradiology in the management of neuroradiologic emergencies]. J Neuroradiol 2005; 31:334-9. [PMID: 15545945 DOI: 10.1016/s0150-9861(04)97012-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
First, to summarize the results of teleradiology programs on neurosurgical emergency care in France. Second, to compare French data with the international literature. Third, to discuss the likely developments and future of teleneuroradiology and teleneurosurgery. Data on French use of telemedicine applications in neuroradiology come from a survey of telemedicine applications in France, which has been conducted in year 2003 at the request of the French ministry of the Research. Teleradiology clearly has a positive impact on emergency neurosurgical care by reducing the time to correct diagnosis and initiation of treatment of patients who need to be transferred and avoid unnecessary transfers. However, present teleradiology applications have organizational limitations that are summarized and discussed with reference to the literature. Further developments in information and communications technology have the potential to revolutionise neurosurgical emergency care and contribute to improve the training of neuroradiology and neurosurgery staff.
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Affiliation(s)
- V Hazebroucq
- MCU-PH de radiologie, AP-HP et Université Paris 5 René Descartes, France
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18
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Noland RB, Quddus MA. Improvements in medical care and technology and reductions in traffic-related fatalities in Great Britain. ACCIDENT; ANALYSIS AND PREVENTION 2004; 36:103-113. [PMID: 14572832 DOI: 10.1016/s0001-4575(02)00132-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Great Britain has one of the lowest levels of traffic-related fatalities in the industrialized world with a current total of about 3500 fatalities per year. Large reductions have occurred over the last 20-30 years and the government has targets of achieving another 40% reduction by 2010. This paper analyzes some of the factors that have been statistically significant in helping to achieve those reductions with a focus on improvements in medical care and technology. Using a cross-sectional time-series of regional data a fixed effects negative binomial (NB) model is estimated which includes three proxies of medical care and technology changes. These are the average length of inpatient stay in the hospital, the per-capita level of National Health Service (NHS) staff, and number of people per-capita waiting for hospital treatment. All are statistically significant with the expected sign showing that improvements in medical technology have reduced total fatalities with less of an impact from changes in medical care. Other variables are also found to be significant, including the percent of elderly people in the population, per-capita expenditure on alcohol, motorway capacity, and average vehicle age. The latter shows a surprisingly unexpected effect, with more older vehicles in a region leading to fewer fatalities. Models evaluating effects on serious and slight injuries are also estimated and serve to confirm the expected effects of medical care and technology.
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Affiliation(s)
- Robert B Noland
- Department of Civil and Environmental Engineering, Center for Transport Studies, Imperial College of Science, Technology and Medicine, London, SW7 2BU, UK.
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19
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Ferguson J, Rowlands A, Palombo A, Pedley D, Fraser S, Simpson S. Minor injuries telemedicine. J Telemed Telecare 2003; 9 Suppl 1:S14-6. [PMID: 12952707 DOI: 10.1258/135763303322196187] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A minor injuries telemedicine network in Grampian connects 14 accident and emergency departments in community hospitals to a teaching hospital department. In a six-month study, 407 new telemedicine consultations met the inclusion criteria. Rates of transfer for treatment to the base hospital were used as an outcome measure. Fourteen out of a total of 19 members of medical staff gave telemedical advice. They were mainly middle-grade accident and emergency doctors. Transfer rates were 16-48% (median 29%) across staff. The rates did not seem to be affected by the base doctor's seniority, but were a reflection of that doctor's experience of and confidence in using videoconferencing equipment for clinical purposes. Transfer rates decreased as experience increased. Training for doctors undertaking the provision of specialist advice should include the clinical practicalities of making remote diagnoses.
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Affiliation(s)
- J Ferguson
- Accident and Emergency Department, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, UK.
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20
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Abstract
In this study, telemedicine and the use of advanced telemedicine technologies are explained. Telemedicine is the use of modern telecommunications and information technologies for the provision of clinical care to individuals at a distance, and transmission of information to provide that care. Telemedicine can be used for decision making, remote sensing, and collaborative arrangements for the real-time management of patients at a distance. The use of telecommunications and information technologies in providing health services is determined. Telemedicine is described as combination of topics from the fields of telecommunication, medicine, and informatics. The medical systems infrastructure consisting of the equipment and processes used to acquire and present clinical information and to store and retrieve data are explained in details. The challenges existing in telemedicine development in different countries are given. Technological, political, and professional barriers in applications of telemedicine are defined. An investigation of telemedicine applications in various fields is presented, and enormous impact of telemedicine systems on the future of medicine is determined.
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Affiliation(s)
- Nihal Fatma Güler
- Department of Electronics and Computer Education, Faculty of Technical Education, Gazi University, Ankara, Turkey.
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21
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Abstract
OBJECTIVE Recent changes in the NHS have seen nurses take on roles that are traditionally filled by doctors, leading to the development of emergency nurse practitioners (ENPs). In addition to this, increasing interest has focused on telemedicine (literally, medicine at a distance) as a way of supporting remote emergency departments and minor injuries units from larger centres. The vast majority of these consultations are related to peripheral limb trauma and require a radiograph to be viewed as an integral part of the telemedical consultation. The aim of this study was therefore to determine whether nurses working alone in a peripheral unit are able to appropriately request, and accurately interpret, peripheral limb radiographs. METHODS In this prospective study the four qualified nurses working in a peripheral unit were permitted to request a defined set of radiographs after limb trauma. A written protocol for nurse requested radiographs was supported by individual teaching sessions. At the time that the radiograph was requested basic demographic details were recorded and the patient was also assessed by two senior doctors in emergency medicine, one in person and one via a telemedicine link, both of whom independently considered whether the radiograph requested by the nurse was appropriate in that patient. Nursing staff were also asked to provide a provisional interpretation of each film, and this was compared with a gold standard derived from the interpretations of the two emergency physicians who had seen the patient and the final radiologist's report. RESULTS The first 300 patients who had a radiograph requested by a member of the nursing staff were studied over a period of 12 months. Altogether 93 radiographs (31%) were positive for recent bony trauma or radio-opaque foreign body. Eleven radiographs (3.7%) were judged by both emergency physicians to be inappropriate. Three radiographs (1%) were requested outside the limits of the protocol, but all three were judged to be appropriate and occurred within the first two months of the study. A total of 32 (10.7%) of the radiographs were incorrectly interpreted by nursing staff with 26 false positives, four false negatives and two cases where the nurse observed an abnormality but failed to identify it correctly. The sensitivity of nurse interpretation was therefore 96%, with a specificity of 87%. CONCLUSION Experienced nurses, working without continuous medical supervision in a remote unit, are able to request appropriate radiographs of the peripheral limbs. Nurses requesting radiographs in this way can also interpret these films to a high standard, though with a tendency to err on the side of caution, generating many more false positive results than false negatives.
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Affiliation(s)
- J R Benger
- Tewkesbury Hospital, Gloucestershire, UK.
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