The use of telemedicine in emergency departments (EDs) is most effective for moderate trauma patients, according to a research paper published in the latest issue of the Medical Journal of Australia.
Professor Johanna Westbrook, from the Health Informatics Research and Evaluation Unit at the University of Sydney, and her co-authors evaluated whether the introduction of an emergency department telemedicine system changed patient management and outcome indicators. The study looked at the use of the Virtual Critical Care Unit (ViCCU), a telemedicine system that allows real-time, broadcast-quality, low-latency audiovisual communications between ED clinicians at different sites.
The study was conducted in the EDs of an 85-bed district hospital and a 420-bed metropolitan tertiary hospital - for one year before and 18 months after the introduction of the ViCCU.
At the end of the study, doctor and nurse clinicians were interviewed on their perceptions of how the ViCCU system impacted on the care provided and their work.
While technological advances have provided new opportunities for the use of telemedicine systems, particularly in time-critical settings such as emergency departments, telemedicine interventions are rarely subjected to the same level of scrutiny as other health interventions, according to the authors. "More concerning is the increasing investment in telemedicine in the absence of robust date on efficacy or effectiveness."
In the study by Professor Westbrook and colleagues, the ViCCU appeared most effective for moderate trauma patients. For these patients, discharges increased significantly (45% to 63%), transfers decreased (48% to 25%), and treatment times increased.
For critical care patients, admissions fell (54% to 30%), transfers increased (21% to 39%), and more procedures were performed.
For major trauma patients, treatment times and the proportion of admissions, discharges and transfers did not change significantly after introduction of the ViCCU.
Clinicians reported that the ViCCU allowed greater support to clinicians at the district hospital, while specialists at the large metropolitan hospital said their workloads had increased and that they felt a greater responsibility for patients at the district hospital, according to the authors.
At the district hospital, nurses reported reduced stress, but doctors reported some loss of autonomy.
The researchers are now calling for large-scale trials of telemedicine systems that include measurements of patient care and the impact on clinicians' work.
The Medical Journal of Australia
is a publication of the Australian Medical Association.