CoChat
Sign Up
Cited by 36Telemedicine and Telehealth ImplementationEmergency and Acute Care StudiesElectronic Health Records Systems

Impact of an ultrabroadband emergency department telemedicine system on the care of acutely ill patients and clinicians’ work

Westbrook, Johanna I, Coiera, Enrico W, Brear, Michelle, Stapleton, Stuart, Rob, Marilyn I, Murphy, Monique, Cregan, Patrick·2008·Medical Journal of Australia
DOI 10.5694/j.1326-5377.2008.tb01850.x
Open this paper in CoChat — free account

Abstract

OBJECTIVES: To evaluate whether introduction of an emergency department (ED) telemedicine system changed patient management and outcome indicators and to investigate clinicians' perceptions of the impact of the system on care provided and on their work. DESIGN: Before-and-after study of use of the Virtual Critical Care Unit (ViCCU), which uses an ultrabroadband connection allowing real-time audiovisual communication between clinicians at distant sites. Semi-structured interviews were conducted with medical and nursing staff at the end of the study. PARTICIPANTS AND SETTING: The ViCCU intervention commenced on 1 January 2004. Our study was conducted in the EDs of an 85-bed district hospital and a 420-bed metropolitan tertiary hospital. It involved all acutely ill patients requiring urgent care (defined by triage category and grouped into critical care, major trauma and moderate trauma) who were treated during the 12 months before (n=169) and 18 months after (n=181) the intervention at the district hospital. Thirty-one of 33 clinicians (doctors and nurses) participating at the two hospitals took part in interviews at the end of the study. MAIN OUTCOME MEASURES: Changes in patterns of management (disposition [admission, discharge or transfer], treatment times, number of procedures) and outcomes (rapid acute physiology scores, hours on ventilation or in intensive care, length of stay). RESULTS: Patient disposition remained unaltered for major trauma patients. For critical care patients, admissions fell significantly (54% to 30%), transfers increased (21% to 39%), and more procedures were performed. For moderate trauma patients, discharges increased significantly (45% to 63%), transfers decreased (48% to 25%) and treatment times were longer. No significant changes were found in outcome indicators. Clinicians reported that the ViCCU allowed greater support to remote clinicians. Specialists reported increased workloads and feelings of greater responsibility for patients at the district hospital. Nurses at the district site reported reduced stress, but district doctors reported some loss of autonomy. CONCLUSIONS: The ViCCU appears most effective for moderate trauma patients, with associated reductions in admissions and transfers. Large-scale trials of telemedicine systems that include measurements of both patient care and impact on clinicians' work are required.

Integrity signals

Registry

Crossref · 10.5694/j.1326-5377.2008.tb01850.x

Cites

12 of 12 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Claims the paper makes

This paper’s full text isn’t openly available, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • The virtual critical care unit demonstrated improved decision-making for patient management, especially for patients in the middle levels of trauma severity, where local management could be enhanced through specialist participation.

    “The system was able to demonstrate improved decision-making for patient-management, especially for those patients in the 'middle' levels of trauma severity, where local management could be enhanced through specialist participation [14].”

    From Recent directions in telemedicine: Review of trends in research and practice (2015) · cites this paper as [14]

Cites

Flagged first, then by citations

Cited by

Sorted by citations

Related

Authors
Westbrook, J. I., Coiera, E. W., Brear, M., Stapleton, S., Rob, M. I., Murphy, M., & Cregan, P.
Affiliations
  • The University of Sydney (AU)
  • UNSW Sydney (AU)
  • Nepean Hospital (AU)
Corresponding author
Westbrook, Johanna I
ORCID
Venue
Medical Journal of Australia
Publisher
AMPCo
Published
2008-06
Volume
188
Issue
12
Pages
704-708
ISSN
  • 0025-729X (ISSN-L)
  • 1326-5377
DOI
10.5694/j.1326-5377.2008.tb01850.x
OpenAlex
W2263432527
Cited by
36
References
10
Citations by year
2024: 1 · 2022: 1 · 2021: 3 · 2020: 2 · 2019: 2 · 2018: 1 · 2017: 3 · 2016: 2 · 2015: 6 · 2013: 4 · 2012: 1
FWCI
3.30
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • The Medical Journal of Australia (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
  • Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
  • Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
Keywords
remote patient care, acute care, trauma patients, critically ill patients, patient disposition, clinician workload, clinician perceptions
MeSH terms
Adolescent, Adult, Aged, Attitude of Health Personnel, Child, Child, Preschool, Critical Care, Emergency Service, Hospital, Female, Hospitals, Rural, Hospitals, Teaching, Humans, Infant, Infant, Newborn, Male, Middle Aged, Patient Admission, Patient Transfer, Triage, Workload, Telemedicine

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review