Telemedicine to a moving ambulance improves outcome after trauma in simulated patients.

BACKGROUND: Rural trauma victims often require prolonged transport by s with limited scopes of practice. We evaluated the impact of telemedicine (TM) to a moving ambulance on outcomes in simulated trauma patients. METHODS: This is an institutional review board approved, prospective double-blind study. Three trauma scenarios (blunt torso trauma, epigastric stab wound, and closed head injury) were created for a human patient simulator. Intermediate emergency medical technicians (EMTs; n = 20) managed the human patient simulator, in a moving ambulance. In the TM group, physicians (n = 12) provided consultation. In the non-TM group, EMTs communicated with medical control by radio, as necessary. We tabulated the fraction of 13 key signs, 5 pathologic processes, and 12 key interventions that were performed. Vital signs and Sao2 (%) were recorded. Data were compared using the Wilcoxon rank-sum test. RESULTS: Lowest Sao2 (84 ± 0.7 vs. 78 ± 0), lowest systolic blood pressure (70 ± 1 vs. 53 ± 1), and highest heart rate (144 ± 0.9 vs. 159 ± 0.5) were significantly improved in the TM group (p < 0.001). Recognition rates for key signs (0.96 ± 0.01 vs. 0.79 ± 0.05), processes (0.98 ± 0.02 vs. 0.75 ± 0.05), and critical interventions (0.92 ± 0.02 vs. 0.49 ± 0.03) were higher in the TM group (p < 0.003). EMTs were successfully guided through needle decompression procedures in 22 of 24 cases (zero in the non-TM group). CONCLUSION: TM to a moving ambulance improved the care of simulated trauma patients. Furthermore, procedurally naïve EMTs were able to perform needle thoracostomy and pericardiocentesis with TM guidance.

Benefits of a telepsychiatry consultation service for rural nursing home residents.

Psychiatric care for nursing home residents is difficult to obtain, especially in rural areas, and this deficiency may lead to significant morbidity or death. Providing this service by videoconference may be a helpful, cost-effective, and acceptable alternative to face-to-face treatment. We analyzed data for 278 telepsychiatry encounters for 106 nursing home residents to estimate potential cost and time savings associated with this modality compared to in-person care. A total of 843.5 hours (105.4 8-hour work days) of travel time was saved compared to in-person consultation for each of the 278 encounters if they had occurred separately. If four resident visits were possible for each trip, the time saved would decrease to 26.4 workdays. Travel distance saved was 43,000 miles; 10,750 miles if four visits per trip occurred. More than $3,700 would be spent on gasoline for 278 separate encounters; decreased to $925 for four visits per roundtrip. Personnel cost savings estimates ranged from $33,739 to $67,477. Physician costs associated with additional travel time ranged from $84,347 to $253,040 for 278 encounters, or from $21,087 to $63,260 for four encounters per visit. The telepsychiatry approach was enthusiastically accepted by virtually all residents, family members, and nursing home personnel, and led to successful patient management. Providing psychiatric care to rural nursing home residents by videoconference is cost effective and appears to be a medically acceptable alternative to face-to-face care. In addition, this approach will allow many nursing homes to provide essential care that would not otherwise be available.

Effectiveness of lectures attended via interactive video conferencing versus in-person in preparing third-year internal medicine clerkship students for Clinical Practice Examinations (CPX).

BACKGROUND: The current practice in medical education is to place students at off-site locations. The effectiveness of these students attending remote lectures using interactive videoconferencing needs to be evaluated. PURPOSE: To determine whether lecture content covering clinical objectives is learned by medical students located at remote sites. METHODS: During the University of Vermont medicine clerkship, 52 medical students attended lectures both in person and via 2-way videoconferencing over a telemedicine network. The study used a crossover design, such that all students attended half of the lectures in person and half using videoconferencing. At the end of the clerkship, students were assessed via a Clinical Practice Examination (CPX), with each student completing 1 exam for material learned in person and 1 for material learned over telemedicine. RESULTS: Exam scores did not differ for the 2 lecture modes, with a mean score of 76% for lectures attended in person and a mean score of 78% for lectures attended via telemedicine (p = 0.66). CONCLUSIONS: Students learn content focused on clinical learning objectives as well using videoconferencing as they do in the traditional classroom setting.

The use of telemedicine for delivering continuing medical education in rural communities.

Physicians in rural communities have limited access to continuing medical education (CME) opportunities. We hypothesized that CME could be delivered via a telemedicine network as effectively as in-person. Our institution delivers CME lectures and grand rounds in Burlington, Vermont, for in-person attendees, and also via a telemedicine network that links 14 hospitals in Vermont and rural northeastern New York. All participants complete an evaluation questionnaire to receive CME credit. We compared the questionnaire responses of those attending in person with those attending via the telemedicine network. From October 1, 2000 to June 30, 2003, there were 4733 CME sessions, 650 of which had both in-person and telemedicine attendees. Responses from these 650 sessions were compared. Most questions relating to lecture quality scored higher for in-person attendees. Compared to having the presenter in the room, telemedicine attendance was judged to be "more effective" in 19% (n = 334), "as effective" in 60%, (n = 1074), and "less effective" in 21% (n = 367). Eighteen percent of telemedicine attendees said they would have traveled to attend the session. Telemedicine-delivered CME was considered at least as effective as in-person CME 79% of the time. Travel was avoided for 18% of the remote attendees. CME was delivered where it would not have been obtained for 82% of the remote attendees. Telemedicine systems can be used to deliver CME, in spite of lower overall ratings compared to in-person attendance.

Medical student evaluations of lectures attended in person or from rural sites via interactive videoconferencing.

BACKGROUND: Interactive videoconferencing may be an effective way for medical students on remote rotations to attend teaching sessions at the main campus. PURPOSE: To compare medical student evaluations of lectures for those attending in person and those attending through interactive videoconferencing. METHODS: Lecture evaluations were completed by medical students on University of Vermont College of Medicine clinical clerkship rotations. Students on clerkships at rural sites attended lectures using our telemedicine network. Responses from in-person and remote attendees were compared. RESULTS: Evaluation forms for 110 lectures were received from 648 in-person and 255 remote attendees. All evaluation items were rated "good" or "excellent" by at least 95% of in-person attendees. Over 90% of remote attendees rated nontelemedicine evaluation items, such as appropriateness of lecture topic for students, as good or excellent. Ratings of telemedicine-specific questions, such as ability to hear the lecturer, were lower. CONCLUSIONS: Level of satisfaction was high for most aspects of remote lecture attendance, although not quite as high as for in-person attendance. Improved technical reliability would likely increase remote attendee satisfaction. Overall, lecture attendance using videoconferencing was found to be an acceptable alternative to travel for medical students in rural clerkships.