1 Department of Emergency Medicine, University of Washington, Seattle, Washington.
2 Department of Pediatrics, Section of Emergency Medicine, Yale University, New Haven, Connecticut.
Telemed J E Health. 2019 Mar;25(3):205-212. doi: 10.1089/tmj.2018.0017. Epub 2018 Jun 29.
Telemedicine provides access to specialty care to critically ill patients from a geographic distance. The effects of using telemedicine on (1) teamwork and communication (TC), (2) task workload during resuscitation, and (3) the processes of critical care have not been well described.
To evaluate the impact of telemedicine on (1) TC, (2) task workload during a resuscitation, and (3) the processes of critical care during a simulated pediatric resuscitation.
Prospective single-center randomized trial. Teams of two physicians (senior and junior resident) and two standardized confederate nurses were randomized to either telemedicine (telepresent senior physician team leader) or usual care (both physicians in the room) during a simulated infant resuscitation. Simulations were video recorded and assessed for teamwork, workload, and processes of care using the Simulated Team Assessment Tool (STAT), the NASA Task Load Index (NASA-TLX) tool, and time between onset of ventricular fibrillation and defibrillation, respectively.
Twenty teams participated. There was no difference in teamwork between the groups (mean STAT score 72% vs. 69%; p = 0.383); however, there was a significantly greater workload in the telemedicine group (mean TLX score 56% vs. 48%, p = 0.020). Using linear regression, no difference was found in time-to-defibrillation between groups (p = 0.671), but higher teamwork scores predicted faster time to defibrillation (p = 0.020).
In this simulation-based study, a telepresent team leader was associated with increased team workload compared to usual care. However, no differences were noted in teamwork and processes of care metrics.
远程医疗使身处地理距离之外的重症患者能够获得专科医疗服务。使用远程医疗对（1）团队合作和沟通（TC）、（2）复苏期间的任务工作量，以及（3）重症监护过程的影响尚未得到很好的描述。
评估远程医疗对（1）TC、（2）复苏期间的任务工作量，以及（3）模拟儿科复苏期间重症监护过程的影响。
前瞻性单中心随机试验。由两名医生（高级和初级住院医生）和两名标准化的代理护士组成的团队，在模拟婴儿复苏期间被随机分配到远程医疗（远程呈现的高级医生组长）或常规护理（两名医生都在房间内）。使用模拟团队评估工具（STAT）、美国国家航空航天局任务负荷指数（NASA-TLX）工具以及从心室颤动开始到除颤之间的时间，对团队合作、工作量和护理过程分别进行视频记录和评估。
共有 20 个团队参与。两组之间的团队合作没有差异（平均 STAT 评分分别为 72%和 69%；p=0.383）；然而，远程医疗组的工作量明显更大（平均 TLX 评分分别为 56%和 48%，p=0.020）。使用线性回归，两组之间的除颤时间无差异（p=0.671），但较高的团队合作评分预测除颤时间更快（p=0.020）。
在这项基于模拟的研究中，与常规护理相比，远程呈现的组长与团队工作负荷增加相关。然而，在团队合作和护理过程指标方面没有差异。
