Telemedicine in pre-hospital care: a review of telemedicine applications in the pre-hospital environment

Abstract

The right person in the right place and at the right time is not always possible; telemedicine offers the potential to give audio and visual access to the appropriate clinician for patients. Advances in information and communication technology (ICT) in the area of video-to-video communication have led to growth in telemedicine applications in recent years. For these advances to be properly integrated into healthcare delivery, a regulatory framework, supported by definitive high-quality research, should be developed. Telemedicine is well suited to extending the reach of specialist services particularly in the pre-hospital care of acute emergencies where treatment delays may affect clinical outcome. The exponential growth in research and development in telemedicine has led to improvements in clinical outcomes in emergency medical care. This review is part of the LiveCity project to examine the history and existing applications of telemedicine in the pre-hospital environment. A search of electronic databases including Medline, Excerpta Medica Database (EMBASE), Cochrane, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) for relevant papers was performed. All studies addressing the use of telemedicine in emergency medical or pre-hospital care setting were included. Out of a total of 1,279 articles reviewed, 39 met the inclusion criteria and were critically analysed. A majority of the studies were on stroke management. The studies suggested that overall, telemedicine had a positive impact on emergency medical care. It improved the pre-hospital diagnosis of stroke and myocardial infarction and enhanced the supervision of delivery of tissue thromboplasminogen activator in acute ischaemic stroke. Telemedicine presents an opportunity to enhance patient management. There are as yet few definitive studies that have demonstrated whether it had an effect on clinical outcome.

Telehealth Nursing Effectiveness in Stroke Patients

“…The use of telehealth and telecommunications technologies helps in promoting self-care management and enhancing health care outcomes in persons with stroke and severe disabilities and is favored by family as well as caregivers [11,12]. Telestroke is aiming to increase patient access, at a lower cost while maintaining the quality of health care[ Figure 3]The importance of matching the telestroke technology to the needs of the population, lessons learned from these investigations, and future directions for research are addressed in these papers [12,13,14].…”

“…The most recent article was published in September, 2017, we can easily observe the timely relevance of the topic of telehealth, nursing and stroke. Four of the selected articles were pertaining to telehealth nursing management and education for stroke patients(10%, n=4) [24,25,27,31], two articles were about the benefits of telestroke for speedy discharge and recovery(5.4%, n=2) [29,34], seven were about telehealth nursing education and care for stroke patients as well as caregivers(18.92%, n=7) [11,12,30,32,33,34,36], two covered the topic of a stroke-specific, care coordination home telehealth (CCHT) program (5.4%,n=2) [18,19], two were related to acceptance of telestroke by caregivers in home setting(5.4%, n=2) [25,37], five articles emphasized how telehealth and such techniques help in savings and decrease stroke patient cost( 13.5%,n=5) [3,14,17,22,28], seven more papers discussed how telemedicine is considered along with other strategies to manage stroke(18.92%, n=7) [7,15,16,20,23,38,39], six papers described the methods in which acute ischemic stroke is managed in emergency medicine with telehealth and related techniques(16.27%,n=6) [2,6,8,9,13,35] and two articles covered how telehealth helps in diagnosis of stroke(5.4%, n=2) [15,29]. Findings suggest that telestroke network usage seems to be beneficial in managing acute ischemic stroke and may decrea...…”

“…Telestroke has a positive clinical impact for stroke patients in many areas of the country previously lacking access to high-quality acute-care services and timely evaluation for appropriate therapies [8,13]. Findings suggest that telestroke network usage seems to be beneficial in managing acute ischemic stroke and may decrease the need for transfer, optimizing the stroke therapy to shorten the hospital stay and to increase the discharge home [2,14].…”

“…An example is the 'hub and spoke model', in underserved areas where stroke management expertise is lacking (i.e. spoke), telemedicine provides an ideal opportunity for supervision by a centrally located stroke expert (hub) [13,14].The use of telehealth and telecommunications technologies helps in promoting self-care management and enhancing health care outcomes in persons with stroke and severe disabilities and is favored by family as well as caregivers [18.19]. Further exploration is needed to determine the effect of telehealth on the various stages of stroke patients and outcomes using studies with highquality design and improved data collection procedures [14,15].…”

“…The emerging themes from the articles emphasize benefits of telestroke for diagnosis of stroke [ 15,29], acute ischemic stroke management in emergency medicine with telehealth and related techniques [2,6,8,9,13,35], speedy discharge and recovery [29,34] and telestroke enhanced prompt treatment, hence improving long-term outcomes [13,16]. Telemedicine has benefited emergency medical services by helping expedite urgent stroke patient transfer, enhance supervision of paramedics and nurses and improve remote patient consultation [13]. Telephone-based nurse case management and home blood pressure monitoring, have proven effective in improving blood pressure control and may reduce the risk of recurrent stroke [17,18].…”