Objectives: To evaluate whether introduction of an emergency department (ED) telemedicine system changed patient management and outcome indicators and to investigate clinicians’ perceptions of the impact of the system on care provided and on their work.
Design: Before-and-after study of use of the Virtual Critical Care Unit (ViCCU), which uses an ultrabroadband connection allowing real-time audiovisual communication between clinicians at distant sites. Semi-structured interviews were conducted with medical and nursing staff at the end of the study.
Participants and setting: The ViCCU intervention commenced on 1 January 2004. Our study was conducted in the EDs of an 85-bed district hospital and a 420-bed metropolitan tertiary hospital. It involved all acutely ill patients requiring urgent care (defined by triage category and grouped into critical care, major trauma and moderate trauma) who were treated during the 12 months before (n = 169) and 18 months after (n = 181) the intervention at the district hospital. Thirty-one of 33 clinicians (doctors and nurses) participating at the two hospitals took part in interviews at the end of the study.
Main outcome measures: Changes in patterns of management (disposition [admission, discharge or transfer], treatment times, number of procedures) and outcomes (rapid acute physiology scores, hours on ventilation or in intensive care, length of stay).
Results: Patient disposition remained unaltered for major trauma patients. For critical care patients, admissions fell significantly (54% to 30%), transfers increased (21% to 39%), and more procedures were performed. For moderate trauma patients, discharges increased significantly (45% to 63%), transfers decreased (48% to 25%) and treatment times were longer. No significant changes were found in outcome indicators. Clinicians reported that the ViCCU allowed greater support to remote clinicians. Specialists reported increased workloads and feelings of greater responsibility for patients at the district hospital. Nurses at the district site reported reduced stress, but district doctors reported some loss of autonomy.
Conclusions: The ViCCU appears most effective for moderate trauma patients, with associated reductions in admissions and transfers. Large-scale trials of telemedicine systems that include measurements of both patient care and impact on clinicians’ work are required.
- 1. Hersh WR, Hefland M, Wallace J, et al. Clinical outcomes resulting from telemedicine interventions: a systematic review. BMC Med Inform Decis Mak [Internet] 2001; 1: 5. Epub 2001; Nov 26. http://www.biomedcentral.com/1472-6947/1/5 (accessed Jan 2008).
- 2. Hailey D, Ohinmaa A, Roine R. Study quality and evidence of benefit in recent assessments of telemedicine. J Telemed Telecare 2004; 10: 318-324.
- 3. Brennan JA, Kealy J, Geradi L, et al. A randomized controlled trial of telemedicine in an emergency department. J Telemed Telecare 1998; 4: 18-20.
- 4. Hailey D, Roine R, Ohinmaa A. Systematic review of evidence for the benefits of telemedicine. J Telemed Telecare 2002; 8 Suppl 1: 1-30.
- 5. Coiera EW, Jayasuriya RA, Hardy J, et al. Communication loads on clinicians in the emergency department. Med J Aust 2002; 176: 415-418. <MJA full text>
- 6. Spencer R, Coiera E, Logan P. Variation in communication loads on clinical staff in the emergency department. Ann Emerg Med 2004; 44: 268-273.
- 7. Cregan P, Stapleton S, Wilson L, et al. The ViCCU Project — achieving virtual presence using ultrabroadband internet in a critical clinical application — initial results. In: Westwood JD, Haluck RS, Hoffman HM, et al, editors. Medicine meets virtual reality 13: the magical next becomes the medical now. Long Beach: IOS Press, 2005: 94-98. (Studies in health technology and informatics Vol. 111.)
- 8. Australian College of Emergency Medicine. Guidelines for implementation of the Australasian Triage Scale in emergency departments. Melbourne: ACEM, 2000. http://www.medeserv.com.au/acem/open/documents/triageguide.htm (accessed Jan 2008).
- 9. Tachakra S, Uko Uche C, Stinson A. Four years’ experience of telemedicine support of a minor accident and treatment service. J Telemed Telecare 2002; 8 Suppl 2: 87-89.
- 10. Lam DM, Mackenzie C. Human and organizational factors affecting telemedicine utilization within US military forces in Europe. Telemed J E Health 2005; 11: 70-78.
- 11. Brebner EM, Brebner J, Ruddick-Bracken H, et al. Evaluation of a pilot telemedicine network for accident and emergency work. J Telemed Telecare 2002; 8 Suppl 2: 5-6.
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