The comparative impact of video-consultation on neurosurgical health services

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Abstract

This study evaluated the impact of telemedicine technology on the provision of neurosurgical health services. We focused on the differences between the use of real time audio-visual teleconferencing and teleradiology versus conventional telephone consultations in the referral of neurosurgical patients from a large district general hospital. All patients requiring emergency neurosurgical consultation were included for randomization into telephone consultation only (Mode A), teleradiology and telephone consultation (Mode B) and video-consultation (Mode C). Measures of effectiveness included diagnostic accuracy and adverse events during the transfer and Glasgow Outcome Score. In a 10-month period, 327 patients were recruited and randomized into the study: the male/female ratio was 2:1 and the number of patients required to be transferred to the neurosurgical unit was 125 (38%). There was a trend towards a more favourable outcome in the video-consultation mode (44%, Mode C), versus teleradiology (31%, Mode B), versus telephone consultation (38%, Mode A). The interim data of this prospective randomized trial suggests that video-consultation may have a favourable impact on emergency neurosurgical consultations.

Introduction

In many developed countries, neurosurgical service is concentrated in regional centres. Traditionally, neurosurgical referrals made from peripheral hospitals were mainly done via telephone. With the advancement of technology, nowadays, neurosurgeons can review radiological information from other hospitals via teleradiology systems. The usual teleradiology system only requires a normal domestic telephone line. The introduction of teleradiology in Neurosurgery had a significant impact on streamlining the process of neurosurgical referrals [1]. With the new improvements in telecommunication technology, it is now possible to communicate with our medical colleagues via a real-time video teleconferencing system. The potential advantage of this technology is, in addition to clinical information and radiological images, that we can now assess the patients themselves in real-time.

This study was conducted in a 1400-bedded teaching hospital and the regional neurosurgical centre serving a population of 2 million. We received referrals mainly from two peripheral hospitals; Alice Ho Mui Ling Hospital and the United Christian Hospital. A new audio-visual teleconferencing system was established between our unit and the United Christian Hospital in 1998 with the use of two Integrated Systems Digital Network (ISDN) lines. In order to evaluate the impact of telemedicine technology in neurosurgical service, we conducted a prospective randomized trial in comparing the efficacy between conventional telephone consultation, teleradiology and video-consultation (Audio-visual teleconferencing) systems.

Section snippets

Teleradiology

The teleradiology system that we use is called Multiview which is a commercially available Windows-based computer software. At the referral hospital there is a capture device installed to their CT scanners which is capable of acquiring and transmitting CT images to our unit via a normal telephone line. The acquisition of the image was done by analogue video frame-grabbing technology giving a resolution of 256×256 matrix.

Audio-visual teleconferencing

The system consists of two cameras, one at each hospital, and a digital

Patients and methods

All patients requiring emergency neurosurgical consultation from the United Christian Hospital were recruited for randomization into telephone consultation only (Mode A), teleradiology and telephone consultation (Mode B) and video-consultation (Mode C). The patients were stratified into three categories, Head injury (Group 1), Cerebrovascular accidents (Group 2) and Miscellaneous (Group 3).

A standard proforma was created for recording the referred patients’ clinical details. This includes the

Results

In a 10-month period (October 1998–July 1999), 327 patients were recruited. 125 patients (38%) required transfer to our neurosurgical centre. The male-to-female ratio was 2:1. The patients were categorized into three groups according to their diagnoses, which includes: (1) Head injury; (2) Cerebrovascular accident (intracerebral haemorrhage, subarachnoid haemorrhage); and (3) Miscellaneous (chronic subdural haematoma, subdural empyema, hydrocephalus, brain tumours). The number of patients in

Discussion

Neurosurgery depends heavily on the computerized digital imaging of the brain in order to diagnose intracranial space-occupying lesion. Early diagnosis and treatment is the key to success in managing emergency neurosurgical patients [3], [4]. This was almost impossible to accomplish before the introduction of teleradiology. The accuracy of the information exchange over the telephone will depend on the experience of the referring physician. Unfortunately, more often the information was

Conclusion

From the result of our pilot study, there are several problems needing to be solved before we can further investigate the use of a video-consultation system in neurosurgery. The problems we faced include the requirement of manpower in escorting the patient and operating the video-consultation system at the referring hospital. More than one video-consultation system may be needed in order to facilitate consultation from different wards. Also, we noted that there was a slight delay in

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