A review of telemedicine in accident and emergency: the story so far

Abstract

Recent developments in information and communications technology have the potential to revolutionise health care. This has been recognised at government level, and plays a significant part in the new information strategy for the NHS "Information For Health". Telemedicine (literally, medicine at a distance) is one of the most successful techniques in this rapidly expanding field, and in preliminary studies has proved to be both successful and popular with patients and health care professionals. In the UK telemedicine has been mainly applied to two major areas of accident and emergency (A&E) practice. These are the transmission of computed tomography scans for urgent neurosurgical opinion and the ongoing support of minor injuries units. The latter also involves transmission and interpretation of radiographs, usually peripheral limb films.Telemedicine is not a medical subspecialty in itself, but a facilitator of all medical and surgical specialties. While recent modernisation initiatives have permitted A&E departments to purchase a range of telemedical equipment, overall progress is hampered by a lack of large or scientifically rigorous studies, and a complete absence of data on the economic implications of this new technique. This review introduces A&E telemedicine in terms that avoid jargon and complex technical details. After a brief consideration of the origins of the subject, attention is given to recent publications relating to minor injuries support and A&E teleradiology. The technical and clinical feasibility of A&E telemedicine are demonstrated, and a case is made for the transmission and interpretation of minor injuries radiographs using a relatively simple and inexpensive system, supported by timely radiological reporting. After a brief study of various legal and ethical issues, the likely developments of the future are discussed. (J Accid Emerg Med 2000;17:157-164)

How good are emergency department Senior House Officers at interpreting X-rays following radiographers?? triage?

“…With advances in technology such as telemedicine or Picture Archiving and Communications System [31], however, it may be that immediate reporting becomes more widespread. If this does become the case, it will probably remove the need for a red dot system altogether, as the gold standard will then be instantly accessible.…”

Can nurses working in remote units accurately request and interpret radiographs?

“…Recent interest has focused on telemedicine (literally, medicine at a distance, facilitated by modern video-conferencing techniques) as a way of supporting such units from larger emergency departments. 4 However, the vast majority of these consultations are related to peripheral limb trauma and require a radiograph to be viewed as an integral part of the telemedical consultation. 5 An important step in developing telemedical support for minor injuries units is therefore to develop a means by which experienced nurses can request appropriate radiographs for peripheral limb trauma before initiating a telemedicine consultation.…”

Prehospital Telemedical Emergency Management of Severely Injured Trauma Patients

“…[34][35][36] Several reviews examined the effect of telemedicine in accident and emergency departments (AED). [37][38][39][40] One meta-analysis 41 and several studies [42][43][44][45][46][47] provide first evidence related to reduced mortality rates, treatment costs and length of in-hospital stay by using inter-hospital telemedicine.…”