1 College of Medicine and Dentistry, James Cook University, Australia.
2 Department of Medical Oncology, Townsville Hospital, Australia.
J Telemed Telecare. 2019 Jan;25(1):3-16. doi: 10.1177/1357633X17734239. Epub 2017 Oct 5.
Telehealth has been used extensively in emergency departments to improve healthcare provision. However, its impact on the management of non-critical emergency presentations within rural and remote emergency department settings has not been adequately explored. The objective of this systematic review is to identify how telehealth has been used to assist in the management of non-critical presentations in rural and remote emergency departments and the outcomes.
Articles were identified through database searches of CINAHL, Cochrane, MEDLINE (OVID), Informit and SCOPUS, as well as the screening of relevant article reference and citation lists. To determine how telehealth can assist in the management of non-critical emergencies, information was extracted relating to telehealth programme model, the scope of service and participating health professionals. The outcomes of telehealth programmes were determined by analysing the uptake and usage of telehealth, the impact on altering a diagnosis or management plan as well as patient disposition including patient transfer, discharge, local hospital admission and rates of discharge against medical advice.
Of the 2532 identified records, 15 were found to match the eligibility criteria and were included in the review. Uptake and usage increased for telehealth programmes predominantly utilised by nursing staff with limited local medical support. Teleconsultation conservatively altered patient diagnosis or management in 18-66% of consultations. Although teleconsultation was associated with increased patient transfer rates, unnecessary transfers were reduced. Simultaneously, an increase in local hospital admission was noted and fewer patients were discharged home. Discharge against medical advice rates were low at 0.9-1.1%.
The most widely implemented hub-and-spoke telehealth model could be incorporated into existing referral frameworks. Telehealth programmes may assist in reducing unnecessary patient transfer and secondary overtriage, while increasing the capacity of emergency department staff to diagnose and manage patients locally, which may translate into increased local hospital admission and reduced discharge rates following teleconsultation.
远程医疗在急诊科被广泛用于改善医疗服务。然而，其在农村和偏远地区急诊科管理非危急症患者方面的作用尚未得到充分探索。本系统评价的目的是确定远程医疗在农村和偏远地区急诊科管理非危急症患者中的应用方式及其效果。
通过 CINAHL、Cochrane、MEDLINE（OVID）、Informit 和 SCOPUS 数据库搜索，并筛选相关文章的参考文献和引文列表，确定了研究的文章。为了确定远程医疗如何帮助管理非危急症，我们提取了与远程医疗计划模式、服务范围和参与的卫生专业人员相关的信息。通过分析远程医疗计划的利用率和使用情况、改变诊断或管理计划的影响以及患者的处置情况（包括患者转院、出院、当地医院入院和无医嘱出院率）来确定远程医疗计划的效果。
在 2532 条记录中，有 15 条符合纳入标准并被纳入本研究。远程医疗计划的利用率和使用量增加，主要由护理人员使用，这些护理人员在当地获得的医疗支持有限。远程会诊保守地改变了 18-66%患者的诊断或管理。尽管远程会诊与患者转院率的增加有关，但减少了不必要的转院。同时，注意到当地医院入院率增加，出院回家的患者减少。无医嘱出院率较低，为 0.9-1.1%。
最广泛实施的中心辐射型远程医疗模式可以纳入现有的转诊框架。远程医疗计划可能有助于减少不必要的患者转院和二次过度分诊，同时增加急诊科工作人员在当地诊断和管理患者的能力，这可能会导致远程会诊后当地医院入院率增加，出院率降低。
