Abstract
Feasibility and safety of ambulance transport between healthcare facilities with medical support exclusively via telemedicine are unknown. This was a retrospective study with a single telemedicine center reference for satellite emergency departments of the same hospital. The study population was all critically ill patients admitted to one of the peripheral units from November 2016 to May 2020 and who needed to be transferred to the main building. Telemedicine-assisted transportation was performed by an emergency specialist. The inclusion criteria included patients above the age of 15 and initial stabilization performed at the emergency department. Unstable, intubated, ST-elevation myocardial infarction and acute stroke patients were excluded. There was a double-check of safety conditions by the nurse and the remote doctor before the ambulance departure. The primary endpoint was the number of telemedicine-guided interventions during transport. 2840 patients were enrolled. The population was predominantly male (53.2%) with a median age of 60 years. Sepsis was the most prevalent diagnosis in 28% of patients, followed by acute coronary syndromes (8.5%), arrhythmia (6.7%), venous thromboembolism (6.1%), stroke (6.1%), acute abdomen (3.6%), respiratory distress (3.3%), and heart failure (2.5%). Only 22 (0.8%) patients required telemedicine-assisted support during transport. Administration of oxygen therapy and analgesics were the most common recommendations made by telemedicine emergency physicians. There were no communication problems in the telemedicine-assisted group. Telemedicine-assisted ambulance transportation between healthcare facilities of stabilized critically ill patients may be an option instead of an onboard physician. The frequency of clinical support requests by telemedicine is minimal, and most evaluations are of low complexity and easily and safely performed by trained nurses.
Highlights
Feasibility and safety of ambulance transport between healthcare facilities with medical support exclusively via telemedicine are unknown
Peer Review History: PLOS recognizes the benefits of transparency in the peer review process; we enable the publication of all of the content of peer review and author responses alongside final, published articles
The study population was all critically ill patients admitted to one of the peripheral units from November 2016 to May 2020 and who needed to be transferred to the main building
Summary
Feasibility and safety of ambulance transport between healthcare facilities with medical support exclusively via telemedicine are unknown. Health-system capillarization is associated with greater efficiency in care, mainly by facilitating access to face-to-face care [1]. The organization of decentralized emergency services is expensive and complex [2]. Life-threatening cases initially stabilized at a satellite community’s emergency department (ED) must be transported to a hospital for complete treatment [3]. Transportation of critically ill patients between hospitals usually requires a highly specialized ambulance team, including a trained driver, paramedics or nurses, and a medical doctor [4]. Keeping a physician available to assist in such transportation is expensive, expanding on idleness and occupational hazard [5]. Brazil’s legislation states that advanced support ambulances must provide medical support [6]
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