Massachusetts General Hospital, MA, USA.
J Telemed Telecare. 2020 Jun;26(5):278-284. doi: 10.1177/1357633X18816112. Epub 2018 Dec 17.
Telemedicine has the potential to improve the delivery of emergency medical care: however, the extent of its adoption in United States (US) emergency departments is not known. Our objective was to characterise the prevalence of telemedicine use among all US emergency departments, describe clinical applications for which it is most commonly used, and identify emergency department characteristics associated with its use.
As part of the National Emergency Department Inventory-USA survey, we queried all 5375 US emergency departments open in 2016. Multivariable logistic regression analyses identified characteristics associated with emergency department receipt of telemedicine services.
Overall, 4507 emergency departments (84%) responded to our survey, with 4031 responding to both telemedicine questions (75%). Although 1694 emergency departments (42%) reported no telemedicine in 2016, most did: 1923 (48%) emergency departments received telemedicine services, 149 (4%) emergency departments received telemedicine services and were in hospitals that provided telemedicine, and 265 emergency departments (7%) did not receive telemedicine but were in hospitals that provided telemedicine services. Among emergency departments receiving telemedicine, the most common applications were stroke/neurology (76%), psychiatry (38%), and paediatrics (15%). In multivariable analysis, telemedicine-receiving emergency departments had higher annual total visit volume for adults and lower annual total visit volume by children; were less likely to be academic or freestanding; and varied by region. In multivariable analysis, emergency departments in telemedicine-providing hospitals had higher annual total visit volume for adults and children, were more likely to be academic and were less likely to be freestanding.
In 2016, telemedicine was used in most US emergency departments (58%), especially for stroke/neurology and psychiatry. Future research is needed to understand the value of telemedicine for different clinical applications, and the barriers to its implementation.
远程医疗有可能改善紧急医疗护理的提供：然而，其在美国（美国）急诊部门的采用程度尚不清楚。我们的目的是描述远程医疗在美国所有急诊部门的使用情况，描述其最常用于哪些临床应用，并确定与使用相关的急诊部门特征。
作为国家急诊部清单-美国调查的一部分，我们询问了 2016 年开放的所有 5375 家美国急诊部。多变量逻辑回归分析确定了与急诊部接受远程医疗服务相关的特征。
总体而言，4507 家急诊部（84%）对我们的调查做出了回应，其中 4031 家对这两个远程医疗问题做出了回应（75%）。尽管 1694 家急诊部（42%）在 2016 年没有远程医疗，但大多数都有：1923 家（48%）急诊部接受远程医疗服务，149 家（4%）急诊部接受远程医疗服务并在提供远程医疗服务的医院，265 家（7%）急诊部没有接受远程医疗服务，但在提供远程医疗服务的医院。在接受远程医疗的急诊部中，最常见的应用是中风/神经病学（76%）、精神病学（38%）和儿科学（15%）。在多变量分析中，接受远程医疗的急诊部接受的成人年总就诊量较高，儿童年总就诊量较低；不太可能是学术或独立的；并且因地区而异。在多变量分析中，在提供远程医疗的医院的急诊部，成人和儿童的年总就诊量较高，更有可能是学术性的，不太可能是独立的。
2016 年，远程医疗在美国大多数急诊部（58%）中得到应用，尤其是在中风/神经病学和精神病学方面。未来的研究需要了解远程医疗在不同临床应用中的价值，以及实施远程医疗的障碍。
