Telemedicine Found Effective in Emergency Departments

The use of telemedicine systems to connect district and central emergency departments (EDs) is most effective for moderate trauma patients, according to a new study.

Researchers at the University of Sydney (NSW, Australia) conducted a study to evaluate whether the introduction of an emergency-department telemedicine system changed patient management and outcome indicators. The study was conducted in the EDs of the 85-bed Blue Mountains District Hospital (Katoomba, Australia), and the 420-bed Nepean Hospital (Sydney, Australia), for one year before and 18 months after the introduction of the Virtual Critical Care Unit (ViCCU). At the end of the study, doctor and nurse clinicians were interviewed on their perceptions of how the ViCCU system affected the care provided, and on their work.

The researchers found that 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 major trauma patients, treatment times and the proportion of admissions, discharges, and transfers did not change significantly after introduction of the ViCCU. For critical care patients, however, admissions fell (54% to 30%), transfers increased (21% to 39%), and more procedures were performed.

According to the authors, the clinicians reported that the ViCCU allowed greater support to clinicians at the district hospital; but whilst nurses reported reduced stress, doctors reported some loss of autonomy. Specialists at the large metropolitan hospital said their workloads had increased and that they felt a greater responsibility for patients at the district hospital. The study was published in the June 16, 2008, issue of the Medical Journal of Australia.

"The ViCCU appears most effective for moderate trauma patients, with associated reductions in admissions and transfers,” concluded lead author Professor Johanna Westbrook, Ph.D., MHA, of the health informatics research and evaluation unit. "Large-scale trials of telemedicine systems that include measurements of both patient care and impact on clinicians' work are required.”

The ViCCU project, a telemedicine system that allows real-time, broadcast-quality, low-latency audiovisual communications between ED clinicians at different sites, sought to address the problems of shortages of critical care staff in regional and rural areas by using the capabilities of ultra-broadband networks so as to have a critical care specialist virtually present at a distant location. The system allows critically ill or injured patients to be routinely assessed and managed remotely, and has led to a more appropriate level of transfers of patients to other hospitals and the delivery of a quality of clinical service not previously available.


Related Links:
University of Sydney
Nepean Hospital