Harper Kelly, McLeod Megan, Brown Summer K, Wilson Georgia, Turchan Maxim, Gittings Emily M, Riebau Derek, Baker Mark, Zimmerman Eli, Charles David
Vanderbilt University Medical Center, Nashville, Tennessee, USA
University of Mississippi, Oxford, Mississippi, USA
Rural Remote Health. 2019 Mar;19(1):4743. doi: 10.22605/RRH4743. Epub 2019 Mar 4.
This study aimed to demonstrate that teleneurology consultations conducted via tablet technology are an efficient and cost-effective means of managing acute neurologic emergencies at community-based hospitals and that utilizing such technology yields high community physician satisfaction.
During a 39-month period, Vanderbilt University Medical Center in Tennessee USA, provided teleneurology services to 10 community-based hospitals that lacked adequate neurology coverage. Hospitalists at one community-based hospital were not comfortable treating any patient with a neurologic symptom, resulting in 100% of those patients being transferred. This facility now retains more than 60% of neurology patients. For less than US$1200, these hospitals were able to meet the only capital expenditure required to launch this service: the purchase of handheld tablet computers. Real-time teleneurology consultations were conducted via tablet using two-way video conferencing, radiologic image sharing, and medical record documentation. Community physicians were regularly surveyed to assess satisfaction.
From February 2014 to May 2017, 3626 teleneurology consultations were conducted. Community physicians, in partnership with neurologists, successfully managed 87% of patients at the community-based hospital. Only 13% of patients required transfer to another facility for a higher level of care. The most common diagnoses included stroke (34%), seizure (11%), and headache/migraine (6%). The average time for the neurologist to answer a request for consultation page and connect with the community physician was 10.6 minutes. Ninety-one percent of community physicians were satisfied or somewhat satisfied with the overall service.
In the assessment of neurology patients, tablets are a more cost-effective alternative to traditional telehealth technologies. The devices promote efficiency in consultations through ease of use and low transfer rates, and survey results indicate community physician satisfaction.
本研究旨在证明，通过平板电脑技术进行远程神经科会诊是社区医院管理急性神经科急症的一种高效且具成本效益的方式，并且利用此类技术能让社区医生满意度很高。
在39个月的时间里，美国田纳西州的范德比尔特大学医学中心为10家缺乏足够神经科诊疗服务的社区医院提供远程神经科服务。一家社区医院的住院医生对治疗任何有神经症状的患者都不放心，导致这些患者100%被转诊。现在这家机构留住了超过60%的神经科患者。这些医院花费不到1200美元，就能满足开展这项服务所需的唯一资本支出：购买手持平板电脑。通过平板电脑利用双向视频会议、放射影像共享和病历记录进行实时远程神经科会诊。定期对社区医生进行调查以评估满意度。
2014年2月至2017年5月，共进行了3626次远程神经科会诊。社区医生与神经科医生合作，成功在社区医院管理了87%的患者。只有13%的患者需要转至另一机构接受更高水平的治疗。最常见的诊断包括中风（34%）、癫痫发作（11%）和头痛/偏头痛（6%）。神经科医生回复会诊请求页面并与社区医生连线的平均时间为10.6分钟。91%的社区医生对整体服务满意或 somewhat 满意。
在评估神经科患者时，平板电脑是比传统远程医疗技术更具成本效益的选择。这些设备通过易用性和低转诊率提高了会诊效率，调查结果表明社区医生满意度较高。
