University of Michigan in Ann Arbor, Michigan.
Boston University, USA.
J Telemed Telecare. 2023 Sep;29(8):579-590. doi: 10.1177/1357633X211010106. Epub 2021 Sep 30.
The impact of telemedicine on the access and quality of paediatric emergency care remains largely unexplored because most studies to date are focused on adult emergency care. We performed a systematic review of the literature to determine if telemedicine is effective in improving quality of paediatric emergency care with regards to access, process measures of care, appropriate disposition, patient-centred outcomes and cost-related outcomes.
We developed a systematic review protocol in accordance with PRISMA (Preferred Reporting Items for Systematic Review) guidelines. We included studies that evaluated the impact of synchronous and asynchronous forms of telemedicine on patient outcomes and process measures in the paediatric emergency care setting. Inclusion criteria were study setting, study design, intervention type, age, outcome measures, publication year and language.
Overall, 1.9% (28/1434) studies met study inclusion and exclusion criteria. These studies revealed that telemedicine increased accuracy of patient assessment in the pre-clinical setting, improved time-to disposition, guided referring emergency department (ED) physicians in performing appropriate life-saving procedures and led to cost savings when compared to regular care. Studies focused on telepsychiatry demonstrated decreased length of stay (LOS), transfer rates and improved patient satisfaction scores.
Our comprehensive review revealed that telemedicine enhances paediatric emergency care, enhances therapeutic decision-making and improves diagnostic accuracy, and reduces costs. Specifically, telemedicine has its most significant impact on LOS, access to specialized care, cost savings and patient satisfaction. However, there was a relative lack of randomized control trials, and more studies are needed to substantiate its impact on morbidity and mortality.
远程医疗对儿科急诊护理的可及性和质量的影响在很大程度上仍未得到探索，因为迄今为止的大多数研究都集中在成人急诊护理上。我们对文献进行了系统回顾，以确定远程医疗是否能有效提高儿科急诊护理的质量，包括可及性、护理过程措施、适当的处置、以患者为中心的结果和与成本相关的结果。
我们根据 PRISMA（系统评价报告的首选项目）指南制定了系统评价方案。我们纳入了评估同步和异步远程医疗形式对儿科急诊护理环境中患者结局和过程测量影响的研究。纳入标准为研究设置、研究设计、干预类型、年龄、结局测量、出版年份和语言。
总体而言，1.9%（28/1434）的研究符合研究纳入和排除标准。这些研究表明，与常规护理相比，远程医疗提高了临床前环境中患者评估的准确性，缩短了处置时间，指导急诊医生进行适当的救生程序，并节省了成本。专注于远程精神病学的研究表明，住院时间（LOS）、转院率降低，患者满意度评分提高。
我们的综合综述表明，远程医疗增强了儿科急诊护理，增强了治疗决策和提高了诊断准确性，并降低了成本。具体而言，远程医疗对 LOS、获得专科护理、成本节约和患者满意度的影响最大。然而，随机对照试验相对较少，需要更多的研究来证实其对发病率和死亡率的影响。
