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Carshagen U, Vlok N. An Air Medical Approach to In-Flight Cardiac Arrest Management. Air Med J 2024; 43:383-389. [PMID: 39293912 DOI: 10.1016/j.amj.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/11/2024] [Accepted: 05/23/2024] [Indexed: 09/20/2024]
Abstract
OBJECTIVE Cardiac arrest during air medical transport is a complex and challenging issue, with unique factors such as limited physical space with restricted access to patients and equipment, small transport teams, limited resources, clinical isolation, effects of altitude, and the need for rapid decision making. The American Heart Association proposed 10 steps to improve outcomes of in-hospital cardiac arrest and serve as the framework for this article. This article aimed to explore these unique challenges and propose a contextual approach that might serve as the basis for improvement projects looking to improve outcomes for affected patients. METHODS This article represents a narrative review of the subject to consolidate the issue of cardiac arrest in the air medical setting specifically. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses literature search extension was used to guide the search strategy and methodology. The applicable items in the literature were selected through searches of the PubMed and Google Scholar databases. The Medical Subject Headings search terms used included "cardiopulmonary resuscitation" or "heart arrest" and "air ambulance" or "air medical transport,'' yielding 477 results. Screening for relevant results for inclusion was based on the relevance of the title or abstract. Articles not written in English or German or addressing commercial air transport were excluded. The reference lists of the included articles were searched for additional literature not included in the original search. RESULTS Three distinct phases are arbitrarily identified by the authors, and the results are discussed under the following headings: pre-arrest, intra-arrest, and post-arrest phases. The pre-arrest phase is characterized by a wide array of concepts such as appropriate goals of care, advanced preparation and action, good clinical governance, patient assessment and handover, system design and ergonomics, sterile cockpit management, appropriate alarm management, and contingency planning in the case of failed resuscitation. The intra-arrest phase is characterized by the contextualization of the usual resuscitation approach, and specific recommendations for immediate nonresuscitative actions, history, hazards, help, airway, breathing, circulation, drugs, and reversible causes are suggested. The post-arrest phase highlights the vulnerable nature of the post-cardiac arrest patient in the air medical setting. Specific considerations regarding postresuscitation care and practitioner well-being are highlighted. CONCLUSION This article outlines a systematic approach to various physical, clinical, mental, and systemic factors that can be used during various phases of the transport journey as well as the individual patient journey. This overview sensitizes individual clinicians or program directors to the factors needing consideration when looking to improve cardiac arrest patient outcomes.
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Affiliation(s)
| | - Neville Vlok
- University of Cape Town, Cape Town, South Africa.
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2
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Osman S, Churruca K, Ellis LA, Luo D, Braithwaite J. The Unintended Consequences of Telehealth in Australia: Critical Interpretive Synthesis. J Med Internet Res 2024; 26:e57848. [PMID: 39190446 PMCID: PMC11387926 DOI: 10.2196/57848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 07/01/2024] [Accepted: 07/16/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND Despite more than 2 decades of telehealth use in Australia and the rapid uptake during the COVID-19 pandemic, little is known about its unintended consequences beyond its planned and intended outcomes. OBJECTIVE The aim of this review was to synthesize evidence on the unintended consequences of telehealth use in Australia to clarify its impact beyond its planned and intended outcomes. METHODS We conducted a search of 4 electronic databases: Ovid MEDLINE, Ovid Embase, EBSCO CINAHL, and Scopus. A critical interpretive synthesis approach was adopted for its flexibility and interpretive nature. We extracted data about study characteristics and the types and models of telehealth services. The extracted unintended consequences were coded and mapped into the domains and dimensions of the Australian Health Performance Framework. RESULTS Of the 4241 records identified by the search, 94 (2.22%) studies were eligible for data extraction and analysis. Of these 94 studies, 23 (24%) reported largely positive unintended consequences of telehealth associated with health status, while 6 (6%) noted a potential negative impact of telehealth on socioeconomic status. The findings of 4 (4%) of the 94 studies highlighted societal and financial consequences of telehealth beyond the health system. Almost all studies (93/94, 99%) reported unintended consequences under the 5 dimensions of the Australian Health Performance Framework. CONCLUSIONS Our synthesis offers a framework for understanding the unintended consequences of the use of telehealth as an alternative to in-person care in Australia. While we have documented many unintended benefits of telehealth use, our findings also shed light on many challenges of delivering care via telehealth across different domains and dimensions. These findings hold significant practice and policy-making implications for ensuring safe and high-quality care delivery via telehealth.
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Affiliation(s)
- Sagda Osman
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Kate Churruca
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Louise A Ellis
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Dan Luo
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
- The Daffodil Centre, Sydney, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
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Greenup EP, Page M, Best D, Best T, Gibbs C. Patterns in the Use of Emergency Telemedicine Support in the Management of Traumatic Road Crashes. Telemed J E Health 2024; 30:579-584. [PMID: 37624653 DOI: 10.1089/tmj.2023.0125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023] Open
Abstract
Objective: The introduction of emergency telemedicine care models is a common theme in health jurisdictions that include rural and remote populations. How the availability of these models influences the way clinicians manage traumatic road crashes is not yet fully understood. This study seeks to compare road crashes where telemedicine was and was not used and to identify any variables that may increase the likelihood of telemedicine usage by treating clinicians. Methods: Road crashes reported in the state Department of Transport and Main Roads (Queensland, Australia) crash database between January 1, 2019, and November 30, 2020 (n = 23,734) were compared to videoconferencing call logs to determine which crashes resulted in treatment that was supported by telemedicine (n = 204). Analysis was performed to examine differences in characteristics related to the crash depending on whether telemedicine support was requested. Results: Road crashes where telemedicine support was requested on average involved more casualties (1.6 vs. 1.41; t(11,287) = -3.26, p < 0.001, relative risk = 1.13). Crashes that occurred in rural settings accounted for most requests for telemedicine (65.68%; X2 = 159.2, p < 0.001) and a greater percentage of crashes in remote locations (3.36% vs. 2.35%; X2 = 256.97, p < 0.001, relative risk = 1.43). The use of telemedicine support for crashes was associated with a 13% increase in the mean number of casualties, compared to crashes where telemedicine support was not used. Conclusion: Telemedicine support is requested by clinicians providing emergency treatment in the management of road crashes that produce more severe injuries, involve multiple casualties, and take place in more rural settings or remote locations.
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Affiliation(s)
| | - Matthew Page
- Clinical Excellence Queensland, Queensland Health, Brisbane, Australia
| | - Daniel Best
- Clinical Excellence Queensland, Queensland Health, Brisbane, Australia
| | - Tiffany Best
- Retrieval Services Queensland, Queensland Health, Brisbane, Australia
| | - Clinton Gibbs
- Retrieval Services Queensland, Queensland Health, Brisbane, Australia
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Dean K, Chang C, McKenna E, Nott S, Hunter A, Tall JA, Setterfield M, Addis B, Webster E. A retrospective observational study of vCare: a virtual emergency clinical advisory and transfer service in rural and remote Australia. BMC Health Serv Res 2024; 24:100. [PMID: 38238698 PMCID: PMC10797963 DOI: 10.1186/s12913-023-10425-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 12/03/2023] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Provision of critical care in rural areas is challenging due to geographic distance, smaller facilities, generalist skill mix and population characteristics. Internationally, the amalgamation telemedicine and retrieval medicine services are developing to overcome these challenges. Virtual emergency clinical advisory and transfer service (vCare) is one of these novel services based in New South Wales, Australia. We aim to describe patient encounters with vCare from call initiation at the referring site to definitive care at the accepting site. METHODS This retrospective observational study reviewed all patients using vCare in rural and remote Australia for clinical advice and/or inter-hospital transfer for higher level of care between February and March 2021. Data were extracted from electronic medical records and included remoteness of sites, presenting complaint, triage category, camera use, patient characteristics, transfer information, escalation of therapeutic intervention and outcomes. Data were summarised using cross tabulation. RESULTS 1,678 critical care patients were supported by vCare, with children (12.5%), adults (50.6%) and older people (36.9%) evenly split between sexes. Clinicians mainly referred to vCare for trauma (15.1%), cardiac (16.1%) and gastroenterological (14.8%) presentations. A referral to vCare led to an escalation of invasive intervention, skill, and resources for patient care. vCare cameras were used in 19.8% of cases. Overall, 70.5% (n = 1,139) of patients required transfer. Of those, 95.1% were transferred to major regional hospitals and 11.7% required secondary transfer to higher acuity hospitals. Of high-urgency referrals, 42.6% did not receive high priority transport. Imaging most requested included CT and MRI scans (37.2%). Admissions were for physician (33.1%) and surgical care (23.3%). The survival rate was 98.6%. CONCLUSION vCare was used by staff in rural and remote facilities to support decision making and care of patients in a critical condition. Issues were identified including low utilisation of equipment, heavy reliance on regional sites and high rates of secondary transfer. However, these models are addressing a key gap in the health workforce and supporting rural and remote communities to receive care.
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Affiliation(s)
- Kimberley Dean
- Orange Health Service, Western NSW Local Health District, 1530 Forest Road, Orange, NSW, 2800, Australia
| | - Cynthia Chang
- Maitland Hospital, Hunter New England Local Health District, 51 Metford Rd, Metford, NSW, 2323, Australia
| | - Erin McKenna
- School of Rural Health, Faculty of Medicine and Health, University of Sydney, 4 Moran Drive, Dubbo, NSW, 2830, Australia
| | - Shannon Nott
- School of Rural Health, Faculty of Medicine and Health, University of Sydney, 4 Moran Drive, Dubbo, NSW, 2830, Australia
- Western NSW Local Health District, 7 Commercial Ave, Dubbo, NSW, 2830, Australia
| | - Amanda Hunter
- vCare Western NSW Local Health District, PO Box 739, Dubbo, NSW, 2830, Australia
| | - Julie A Tall
- Health Intelligence Unit, Western NSW Local Health District, Ward 22, Bloomfield Campus, Locked Bag 6008, Orange, NSW, 2800, Australia
| | - Madeline Setterfield
- School of Rural Health, Faculty of Medicine and Health, University of Sydney, 4 Moran Drive, Dubbo, NSW, 2830, Australia
| | - Bridget Addis
- School of Rural Health, Faculty of Medicine and Health, University of Sydney, 4 Moran Drive, Dubbo, NSW, 2830, Australia
| | - Emma Webster
- School of Rural Health, Faculty of Medicine and Health, University of Sydney, 4 Moran Drive, Dubbo, NSW, 2830, Australia.
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Santomauro C, McLanders M, Rae A. Experiences of rural clinicians accessing specialist support via telehealth for trauma and emergency care in Queensland, Australia. Digit Health 2024; 10:20552076241251950. [PMID: 39070889 PMCID: PMC11282562 DOI: 10.1177/20552076241251950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2024] [Indexed: 07/30/2024] Open
Abstract
Objective Trauma and emergency patients presenting to rural facilities require time-critical treatment and management that is sometimes beyond the scope of clinicians in the facility. In Queensland, Australia's second largest state, telehealth infrastructure facilitates 24/7 communication between rural clinicians and tertiary-based critical care specialists. We sought to understand the current state of Queensland's emergency telehealth system from the perspective of direct end-users to inform future improvement efforts and resource allocation. Methods Semi-structured interviews were conducted with 11 rural Queensland clinicians who use telehealth to access specialist support during critical presentations. Qualitative data were analysed in three inductive phases: immersion; a combination of process coding and in vivo coding; and focused coding. Results The findings highlight that emergency telehealth support provides benefits beyond better patient care, as it fosters collegiality and alleviates professional isolation. Three key themes were identified: (a) strategies for overcoming challenges in providing trauma and emergency care in rural Queensland; (b) factors that affect perceptions of telehealth effectiveness; and (c) how support for rural trauma and emergency care can be improved. To provide context for the themes, a summary of scene-setting data is also provided. Conclusions There are both advantages and disadvantages for rural clinicians accessing telehealth specialist support for critical care. Although telehealth is seen as a vital service that supports rural clinicians and benefits patient care, the findings suggest that tools, systems and processes surrounding rural trauma and emergency care could benefit from streamlining, integration, and the introduction of fit-for-purpose technologies. Addressing limitations of efficiencies would improve support for rural clinicians and likely improve patient outcomes for rural communities.
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Affiliation(s)
- Chiara Santomauro
- Safety Science Innovation Lab, Griffith University, Brisbane, QLD, Australia
- School of Psychology, The University of Queensland, Brisbane, QLD, Australia
| | - Mia McLanders
- Safety Science Innovation Lab, Griffith University, Brisbane, QLD, Australia
- School of Psychology, The University of Queensland, Brisbane, QLD, Australia
- Clinical Skills Development Service, Metro North Health, Brisbane, QLD, Australia
| | - Andrew Rae
- Safety Science Innovation Lab, Griffith University, Brisbane, QLD, Australia
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Furness K, Howe J, Chipman M, Parsotam N, O'Connor M. The Commonwealth Criminal Code restricts the use of carriage services to access voluntary assisted dying in Victoria: a perspective. AUST HEALTH REV 2023; 47:64-66. [PMID: 36455872 DOI: 10.1071/ah22192] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/12/2022] [Indexed: 12/03/2022]
Abstract
A major barrier to Victorians with a terminal illness accessing voluntary assisted dying is the Commonwealth Criminal Code Amendment (Suicide Related Material Offences ) 2005 (the Code), which prohibits the use of any electronic forms of communication when discussing suicide. The proliferation of telehealth as a means of access to medical practitioners as a result of the COVID-19 pandemic has heightened the anachronistic prohibition of such communication in relation to voluntary assisted dying, particularly in Victoria, as the federal law arguably prohibits its use. In this paper we explore the definition of suicide and its application to voluntary assisted dying and argue for a revision of the Code, to enable equitable and timely access to voluntary assisted dying for people of Victoria.
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Affiliation(s)
- Kate Furness
- Safer Care Victoria, 50 Lonsdale Street, Melbourne, Vic. 3000, Australia; and Department of Nursing and Allied Health, School of Health Sciences, Swinburne University, John Street, Hawthorn, Vic. 3122, Australia
| | - Jim Howe
- Safer Care Victoria, 50 Lonsdale Street, Melbourne, Vic. 3000, Australia; and School of Rural Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Wellington Road, Clayton, Vic. 3800, Australia
| | - Mitchell Chipman
- Safer Care Victoria, 50 Lonsdale Street, Melbourne, Vic. 3000, Australia; and School of Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Wellington Road, Clayton, Vic. 3800, Australia; and Victorian Breast and Oncology Care, 166 Gipps Street, East Melbourne, Vic. 3002, Australia; and Alfred Health, 55 Commercial Road, Prahran, Vic. 3004, Australia; and Epworth Health, 89 Bridge Road, Richmond, Vic. 3121, Australia
| | - Nirasha Parsotam
- Safer Care Victoria, 50 Lonsdale Street, Melbourne, Vic. 3000, Australia; and Health Innovation Program, Murdoch Children's Research Institute, Royal Children's Hospital, 50 Flemington Road, Parkville, Vic. 3052, Australia; and Institute of Healthcare Improvement (IHI), Asia-Pacific Region, Melbourne, Vic., Australia
| | - Margaret O'Connor
- Safer Care Victoria, 50 Lonsdale Street, Melbourne, Vic. 3000, Australia; and School of Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Wellington Road, Clayton, Vic. 3800, Australia; and Melbourne City Mission Palliative Care, 230 Normanby Avenue, Thornbury, Vic. 3071, Australia
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Paddock S, Norman C. Telehealth training: Interprofessional mixed reality simulation in a retrieval service setting. Emerg Med Australas 2021; 34:134-136. [PMID: 34693640 DOI: 10.1111/1742-6723.13891] [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: 09/11/2021] [Revised: 10/05/2021] [Accepted: 10/10/2021] [Indexed: 11/27/2022]
Abstract
The use of Telehealth is well established in Australian retrieval service settings to aid assessment and management of patients requiring aeromedical transportation and to provide support to clinicians at remote facilities. Telehealth ensures prompt advice and treatment for critically ill and injured patients and can facilitate a resuscitation until the retrieval team arrives. There is scant information regarding the knowledge, skills and abilities required of Telehealth professionals, despite the universal recognition of it requiring a complex skill set, comprehensive understanding of technology and mastery of retrieval medicine. We share the experiences of the South Australia Ambulance Service MedSTAR Emergency Medical Retrieval Service preparing an education programme focussed on the psychometric skills in Telehealth. Our programme realistically simulates Telehealth and coordination systems in use across South Australia, provides in-depth hands-on practice for medical and nursing staff that incorporates teamwork, communication, technical and critical thinking skills and culminates with a mixed-reality simulation scenario and formal debrief.
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Affiliation(s)
- Sharon Paddock
- South Australia Ambulance Service, MedSTAR Emergency Medical Retrieval Service, Adelaide, South Australia, Australia
| | - Chantelle Norman
- South Australia Ambulance Service, MedSTAR Emergency Medical Retrieval Service, Adelaide, South Australia, Australia
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Acceptability and Perceived Utility of Telemedical Consultation during Cardiac Arrest Resuscitation. A Multicenter Survey. Ann Am Thorac Soc 2020; 17:321-328. [DOI: 10.1513/annalsats.201906-485oc] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Donohue LT, Hoffman KR, Marcin JP. Use of Telemedicine to Improve Neonatal Resuscitation. CHILDREN (BASEL, SWITZERLAND) 2019; 6:E50. [PMID: 30939758 PMCID: PMC6518228 DOI: 10.3390/children6040050] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 03/25/2019] [Accepted: 03/26/2019] [Indexed: 12/14/2022]
Abstract
Most newborn infants do well at birth; however, some require immediate attention by a team with advanced resuscitation skills. Providers at rural or community hospitals do not have as much opportunity for practice of their resuscitation skills as providers at larger centers and are, therefore, often unable to provide the high level of care needed in an emergency. Education through telemedicine can bring additional training opportunities to these rural sites in a low-resource model in order to better prepare them for advanced neonatal resuscitation. Telemedicine also offers the opportunity to immediately bring a more experienced team to newborns to provide support or even lead the resuscitation. Telemedicine can also be used to train and assist in the performance of emergent procedures occasionally required during a neonatal resuscitation including airway management, needle thoracentesis, and umbilical line placement. Telemedicine can provide unique opportunities to significantly increase the quality of neonatal resuscitation and stabilization in rural or community hospitals.
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Affiliation(s)
- Lee T Donohue
- University of California at Davis Children's Hospital, 2516 Stockton Blvd, Sacramento, CA 95817, USA.
| | - Kristin R Hoffman
- University of California at Davis Children's Hospital, 2516 Stockton Blvd, Sacramento, CA 95817, USA.
| | - James P Marcin
- University of California at Davis Children's Hospital, 2516 Stockton Blvd, Sacramento, CA 95817, USA.
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Zachrison KS, Boggs KM, M Hayden E, Espinola JA, Camargo CA. A national survey of telemedicine use by US emergency departments. J Telemed Telecare 2018; 26:278-284. [DOI: 10.1177/1357633x18816112] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective Telemedicine has the potential to improve the delivery of emergency medical care: however, the extent of its adoption in United States (US) emergency departments is not known. Our objective was to characterise the prevalence of telemedicine use among all US emergency departments, describe clinical applications for which it is most commonly used, and identify emergency department characteristics associated with its use. Methods As part of the National Emergency Department Inventory-USA survey, we queried all 5375 US emergency departments open in 2016. Multivariable logistic regression analyses identified characteristics associated with emergency department receipt of telemedicine services. Results Overall, 4507 emergency departments (84%) responded to our survey, with 4031 responding to both telemedicine questions (75%). Although 1694 emergency departments (42%) reported no telemedicine in 2016, most did: 1923 (48%) emergency departments received telemedicine services, 149 (4%) emergency departments received telemedicine services and were in hospitals that provided telemedicine, and 265 emergency departments (7%) did not receive telemedicine but were in hospitals that provided telemedicine services. Among emergency departments receiving telemedicine, the most common applications were stroke/neurology (76%), psychiatry (38%), and paediatrics (15%). In multivariable analysis, telemedicine-receiving emergency departments had higher annual total visit volume for adults and lower annual total visit volume by children; were less likely to be academic or freestanding; and varied by region. In multivariable analysis, emergency departments in telemedicine-providing hospitals had higher annual total visit volume for adults and children, were more likely to be academic and were less likely to be freestanding. Conclusion In 2016, telemedicine was used in most US emergency departments (58%), especially for stroke/neurology and psychiatry. Future research is needed to understand the value of telemedicine for different clinical applications, and the barriers to its implementation.
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Real-time video telemedicine applications in the emergency department: a scoping review of literature. CAN J EMERG MED 2017; 20:920-928. [DOI: 10.1017/cem.2017.382] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
AbstractObjectivesTo collect and synthesize the literature describing the use of real-time video-based technologies to provide support in the care of patients presenting to emergency departments.Data SourceSix electronic databases were searched, including Medline, CINAHL, Embase, the Cochrane Database, DARE, and PubMed for all publications since the earliest date available in each database to February 2016.Study SelectionSelected articles were full text articles addressing the use of telemedicine to support patient care in pre-hospital or emergency department settings. The search yielded 2976 articles for review with 11 studies eligible for inclusion after application of the inclusion and exclusion criteria. A scoping review of the selected articles was performed to better understand the different systems in place around the world and the current state of evidence supporting telemedicine use in the emergency department.ConclusionsTelemedicine support for emergency department physicians is an application with significant potential but is still lacking evidence supporting improved patient outcomes. Advances in technology, combined with more attractive price-points have resulted in widespread interest and implementation around the world. Applications of this technology that are currently being studied include support for minor treatment centres, patient transfer decision-making, management of acutely ill patients and scheduled teleconsultations.
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