Stage 2. The Safety And Effectiveness Of Minor Injuries Telemedicine

Objectives

To determine the safety of minor injuries telemedicine compared with on-site specialist care, current practice and a robust gold standard, and to assess the clinical effectiveness of this new technique.

Methods

Patients presenting to a small peripheral hospital within ten days of injury were separately assessed by each of: an emergency medicine specialist based at a district general hospital using telemedicine, a second on-site emergency medicine specialist, and an on-site general practitioner (representing current practice). The primary outcome measure was discrepancies between these three medical assessments and a gold standard. All patients were subsequently randomised to follow one of the independent treatment plans generated by the above assessments. Secondary outcomes were recovery and further use of healthcare services measured seven days after recruitment, and consultation duration.

 PictureTel Swiftsite videoconferencing system

Telemedicine equipment used at the peripheral hospital:
PictureTel SwiftsiteTM videoconferencing system, PictureTel 550TM document camera for X-ray transmission, and a Panasonic VX54BTM camera to provide close-up views. The equipment was installed and optimised four weeks before the start of the study.

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Results

600 patients were recruited over a 12-month period. Overall, 73 discrepancies were identified, with 12 important over-treatments and 11 important under-treatments. No consultation modality was clearly superior to any other, and there were no statistically significant differences in the secondary outcomes of clinical effectiveness measured at 7 days. The mean duration of a telemedicine consultation (6.0 min.) was almost twice as long as an on-site specialist (3.1 min.) or on-site general practitioner consultation (3.4 min.) (p<0.0001 in both cases).

Conclusions

In the management of minor injuries, telemedicine is both safe and clinically effective, providing care that is equivalent to specialist on-site assessment and the current practice of treatment by a general practitioner. There is no evidence that telemedicine provides superior care, and there are a number of process issues that may impede successful implementation of this new technique.