A cohort study of early neurological consultation by telemedicine on the care of neurological inpatients

Abstract

Objectives: To find out the effect of early neurological consultation using a real time video link on the care of patients with neurological symptoms admitted to hospitals without neurologists on site. Methods: A cohort study was performed in two small rural hospitals: Tyrone County Hospital (TCH), Omagh, and Erne Hospital, Enniskillen. All patients over 12 years of age who had been admitted because of neurological symptoms, over a 24 week period, to either hospital were studied. Patients admitted to TCH, in addition to receiving usual care, were offered a neurological consultation with a neurologist 120 km away at the Neurology Department of the Royal Victoria Hospital, Belfast, using a real time video link. The main outcome measure was length of hospital stay; change of diagnosis, mortality at 3 months, inpatient investigation, and transfer rate and use of healthcare resources within 3 months of admission were also studied. Results: Hospital stay was significantly shorter for those admitted to TCH (hazard ratio 1.13; approximate 95% CI 1.003 to 1.282; p = 0.045). No patients diagnosed by the neurologist using the video link subsequently had their diagnosis changed at follow up. There was no difference in overall mortality between the groups. There were no differences in the use of inpatient hospital resources and medical services in the follow up period between TCH and Erne patients. Conclusions: Early neurological assessment reduces hospital stay for patients with neurological conditions outside of neurological centres. This can be achieved safely at a distance using a real time video link.

Liaison neurology for acute medical admissions

“…Comparison between physicians and neurologists in the second cohort showed significant changes in diagnosis in over one third of patients. These results are similar to our study comparing neurological consultation by real-time videolink with conventional care at two rural hospitals, 1 and suggest that early involvement of specialists in emergency care can improve outcomes. Liaison neurology has been proposed as a way of improving access to specialist neurology advice, 2 and we now have evidence of its efficacy.…”

Systematic Review of Teleneurology

“…Of note, Patterson was a coinvestigator in both the studies by Craig et al of teleneurologic consultations with patients in rural hospitals in Northern Ireland. Another article by Craig et al 13 details their cohort study of early teleneurologic consultation in a hospital in rural Northern Ireland when compared to usual care in a hospital of similar size, resources, and population served, which had no neurologist on-site. The hospital that offered teleneurologic consultation served a population of 62 000 people, and the other rural hospital, which otherwise receives neurologic consultative services once monthly, served 57 000 people.…”

“…Given the nascency of neurohospitalist practice as an academic subspecialty within neurology, and its corresponding dearth of supporting medical literature, research needs are many and priorities are difficult to assign. Craig et al 11,13 have provided the field with the least initial evidence that the practice of teleneurologic consultation is technically feasible and provides acceptable clinical results. Douglas et al 16 provide compelling evidence that the neurohospitalist model can improve quality of care and patient outcomes, and it is the opinion of the authors that it is not unreasonable to expect a similar benefit from teleneurohospitalist consultation, although this is yet to be studied.…”

Future Neurohospitalist

“…Headache disorders and symptoms affecting speech or language also have the potential to be effectively evaluated by a teleneurohospitalist. Teleneurology may be of particular value in underserved rural areas or in developing countries which otherwise would be without any neurological expertise, [97][98][99][100][101][102][103][104][105][106][107][108][109] and provides similar benefits of earlier evaluation especially of acute neurological disorders other than stroke, such as spinal cord injury 110,111 and even epilepsy. 112 The critical care unit is another domain where robotic telepresence or teleneurology serves to monitor critically ill patients, evaluate unexplained coma, and respond quickly to unstable patients.…”