1 Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa.
2 Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, Iowa.
Telemed J E Health. 2019 Feb;25(2):93-100. doi: 10.1089/tmj.2018.0013. Epub 2018 Jun 29.
Meeting time goals for patients with time-sensitive conditions can be challenging in rural emergency departments (EDs), and adopting policies is critical. ED-based telemedicine has been proposed to improve quality and timeliness of care in rural EDs.
The objective of this study was to test the hypothesis that diagnostic testing in telemedicine-supplemented ED care for patients with myocardial infarction (MI) and stroke would be faster than nontelemedicine care in rural EDs.
This observational cohort study included all ED patients with MI or stroke in 19 rural critical access hospitals served by a single real-time contract-based telemedicine provider in the upper Midwest (2007-2015). The primary outcome for the MI cohort was time-to-electrocardiogram (EKG) and for the stroke cohort was time-to-head computed tomography (CT) interpretation. To measure the relationship between telemedicine and timeliness parameters, generalized estimating equations models were used, clustering on presenting hospital.
Of participating ED visits, 756 were included in the MI cohort (29% used telemedicine) and 140 were included in the stroke cohort (30% used telemedicine). Time-to-EKG did not differ when telemedicine was used (1% faster, 95% confidence interval [CI] -4% to 7%), or after telemedicine was implemented (4% faster, 95% CI -3% to 10%). Head CT interpretation was faster for telemedicine cases (15% faster, 95% CI 4-26%). No differences were observed in time to reperfusion therapy.
Telemedicine implementation was associated with more timely head CT interpretation for rural patients with stroke, but no difference in early MI care. Future work will focus on the specific manner in which telemedicine changes ED care processes and ongoing professional education.
在农村地区的急诊部门（ED），满足时间敏感条件的患者的就诊时间目标可能具有挑战性，因此采用相关政策至关重要。基于 ED 的远程医疗已被提议用于改善农村 ED 的护理质量和及时性。
本研究的目的是检验以下假设，即对于农村 ED 中患有心肌梗死（MI）和中风的患者，在补充远程医疗的 ED 护理中进行诊断检测的速度快于非远程医疗护理。
本观察性队列研究包括中西部地区由单一实时合同远程医疗供应商提供服务的 19 家农村关键通道医院的所有 ED 中患有 MI 或中风的患者（2007-2015 年）。MI 队列的主要结局是心电图（EKG）的时间，中风队列的主要结局是头部计算机断层扫描（CT）解读的时间。为了衡量远程医疗与及时性参数之间的关系，使用广义估计方程模型，在呈现医院上进行聚类。
在参与的 ED 就诊中，有 756 例纳入 MI 队列（29%使用远程医疗），140 例纳入中风队列（30%使用远程医疗）。当使用远程医疗时，EKG 时间没有差异（快 1%，95%置信区间 [CI] -4%至 7%），或者在实施远程医疗后，EKG 时间也没有差异（快 4%，95% CI -3%至 10%）。远程医疗病例的头部 CT 解读更快（快 15%，95% CI 4%至 26%）。在再灌注治疗时间方面，没有观察到差异。
远程医疗的实施与农村中风患者的头部 CT 解读时间更及时相关，但对早期 MI 护理没有差异。未来的工作将集中于远程医疗改变 ED 护理流程的具体方式以及正在进行的专业教育。
