Abstract
Objectives: To determine the safety of minor injuries telemedicine compared with on-site specialist care, current practice, and a robust gold standard, and to assess the clinical effectiveness of this new technique.
Methods: Patients presenting to a peripheral hospital within 10 days of injury were separately assessed by each of: an emergency medicine specialist based at a district general hospital using telemedicine, a second on-site emergency medicine specialist, and an on-site general practitioner (representing current practice). The primary outcome measure was discrepancies between these three medical assessments and a gold standard. All patients were subsequently randomised to follow one of the independent treatment plans generated by the above assessments. Secondary outcomes were recovery and further use of healthcare services measured seven days after recruitment, and consultation duration.
Results: 600 patients were recruited over a 12 month period. Overall, 73 discrepancies were identified, with 12 important over-treatments and 11 important under-treatments. No consultation modality was clearly superior to any other, and there were no statistically significant differences in the secondary outcomes of clinical effectiveness measured at seven days. The mean duration of a telemedicine consultation (6.0 min) was almost twice as long as an on-site specialist (3.1 min) or on-site general practitioner consultation (3.4 min) (p<0.0001 in both cases).
Conclusions: Minor injuries telemedicine is safe and clinically effective, providing care that is equivalent to specialist on-site assessment and the current practice of treatment by a general practitioner. There is no evidence that telemedicine provides superior care, and there are a number of process issues that may impede successful implementation of this new technique.
Full Text
The Full Text of this article is available as a PDF (90.9 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Armstrong I. J., Haston W. S. Medical decision support for remote general practitioners using telemedicine. J Telemed Telecare. 1997;3(1):27–34. doi: 10.1258/1357633971930166. [DOI] [PubMed] [Google Scholar]
- Benger J. A review of telemedicine in accident and emergency: the story so far. J Accid Emerg Med. 2000 May;17(3):157–164. doi: 10.1136/emj.17.3.157. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Benger J., Lock A., Cook J., Kendall J. The effect of resolution, compression, colour depth and display modality on the accuracy of accident and emergency telemedicine. J Telemed Telecare. 2001;7 (Suppl 1):6–7. doi: 10.1177/1357633X010070S102. [DOI] [PubMed] [Google Scholar]
- Brebner J. A., Ruddick-Bracken H., Norman J. N., Page J. G. The nurse practitioner: management of minor trauma. Accid Emerg Nurs. 1996 Jan;4(1):43–46. doi: 10.1016/s0965-2302(96)90039-9. [DOI] [PubMed] [Google Scholar]
- Brennan J. A., Kealy J. A., Gerardi L. H., Shih R., Allegra J., Sannipoli L., Lutz D. A randomized controlled trial of telemedicine in an emergency department. J Telemed Telecare. 1998;4 (Suppl 1):18–20. doi: 10.1258/1357633981931911. [DOI] [PubMed] [Google Scholar]
- Darkins A., Dearden C. H., Rocke L. G., Martin J. B., Sibson L., Wootton R. An evaluation of telemedical support for a minor treatment centre. J Telemed Telecare. 1996;2(2):93–99. doi: 10.1177/1357633X9600200205. [DOI] [PubMed] [Google Scholar]
- Freij R. M., Duffy T., Hackett D., Cunningham D., Fothergill J. Radiographic interpretation by nurse practitioners in a minor injuries unit. J Accid Emerg Med. 1996 Jan;13(1):41–43. doi: 10.1136/emj.13.1.41. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Guly H. R. Risk management. J Accid Emerg Med. 1997 Nov;14(6):408–410. doi: 10.1136/emj.14.6.408. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hanley J. A., Lippman-Hand A. If nothing goes wrong, is everything all right? Interpreting zero numerators. JAMA. 1983 Apr 1;249(13):1743–1745. [PubMed] [Google Scholar]
- McLaren P., Ball C. J. Telemedicine: lessons remain unheeded. BMJ. 1995 May 27;310(6991):1390–1391. doi: 10.1136/bmj.310.6991.1390. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Read S. M., Jones N. M., Williams B. T. Nurse practitioners in accident and emergency departments: what do they do? BMJ. 1992 Dec 12;305(6867):1466–1470. doi: 10.1136/bmj.305.6867.1466. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Squibb N. J. Video transmission for telemedicine. J Telemed Telecare. 1999;5(1):1–10. doi: 10.1258/1357633991932306. [DOI] [PubMed] [Google Scholar]
- Tachakra S., Sivakumar A., Hayes J., Dawood M. A protocol for telemedical consultation. J Telemed Telecare. 1997;3(3):163–168. doi: 10.1258/1357633971931084. [DOI] [PubMed] [Google Scholar]
- Tachakra S., Wiley C., Dawood M., Sivakumar A., Dutton D., Hayes J. Evaluation of telemedical support to a free-standing minor accident and treatment service. J Telemed Telecare. 1998;4(3):140–145. doi: 10.1258/1357633981932118. [DOI] [PubMed] [Google Scholar]
- Wears R. L., Li S., Hernandez J. D., Luten R. C., Vukich D. J. How many myocardial infarctions should we rule out? Ann Emerg Med. 1989 Sep;18(9):953–963. doi: 10.1016/s0196-0644(89)80460-3. [DOI] [PubMed] [Google Scholar]
- Weatherburn G., Bryan S., Nicholas A., Cocks R. The effect of a picture archiving and communications system (PACS) on diagnostic performance in the accident and emergency department. J Accid Emerg Med. 2000 May;17(3):180–184. doi: 10.1136/emj.17.3.180. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Wootton R., Dornan J., Fisk N. M., Harper A., Barry-Kinsella C., Kyle P., Smith P., Yates R. The effect of transmission bandwidth on diagnostic accuracy in remote fetal ultrasound scanning. J Telemed Telecare. 1997;3(4):209–214. doi: 10.1258/1357633971931183. [DOI] [PubMed] [Google Scholar]