Abstract
BackgroundEmergency physicians are responsible for assessing the severity of a patient’s burns, which determines whether the patient needs to be transferred to a burn center. Such a proper assessment represents a daunting task because severe burn injuries are rare. Inaccurate estimates often result in unjustified and costly transfers and unneeded fluid resuscitation and assisted ventilation procedures. Telemedicine offers a solution to these challenges. The present pilot study aims to investigate the feasibility, acceptability, and potential value of a large telemedicine initiative at the University of Montreal Health Center’s burn center and its network of referring hospitals.MethodsA three-stage study protocol is proposed to achieve this objective. First, a proof of concept phase will assess the technical feasibility of telemedicine at one referring hospital with a high volume of patient transfers. Second, the organizational and human feasibility of the project will be evaluated in four referring medical centers. All teleconsultation sessions will be analyzed using the WHO’s telemedicine implementation model. The third phase will consist of evaluating the potential impacts of telemedicine in a subset of 10 referring hospitals. The quality of communications between referring physicians and specialists will be assessed using semi-structured interviews. A pre-test/post-test with a comparison group design will be used to assess the effects of telemedicine on patient transfers, ventilation procedures, patient complications, mortality, length of ICU stay, and additional surgical procedures. The economic viability of telemedicine will be assessed using a cost-minimization approach.DiscussionThe telemedicine initiative is expected to yield positive and significant outcomes that are relevant to a wide range of medical centers that already use or are considering using a similar technology. The contribution of this pilot study lies in its ability to reveal technological, organizational, and human barriers and provide a preliminary assessment of the clinical and economic value of a large-scale telemedicine initiative in the context of burn medicine.
Highlights
MethodsA three-stage study protocol is proposed to achieve this objective
Emergency physicians are responsible for assessing the severity of a patient’s burns, which determines whether the patient needs to be transferred to a burn center
Considering that trauma patients have better outcomes when they receive timely treatment at a specialized center [25], that delays to definitive treatment have a negative impact on survival and long-term morbidity following a traumatic event [25], and that triaging burn patients represents a challenging task because severe burn injuries are rare [26], it becomes vital to connect providers at referring hospitals with medical experts for real-time advice on the early management of these patients
Summary
Study setting CHUM is one of the largest medical centers in Canada. It is a public not-for-profit hospital whose primary mission is to provide inpatient and ambulatory care to its immediate urban clientele, as well as specialized and ultra-specialized services to the broader metropolitan and provincial population. Phase 1: technical feasibility The first phase will consist of evaluating the project’s technical feasibility in terms of various operational issues, such as access to a wireless communications network (a mobile or Wi-Fi network) in the emergency room, the user-friendliness of the telemedicine app, and the fluidity of discussions between the referring physician, the medical specialist, and COFR staff. Various technical tests (login, connectivity, audio/video problems, etc.) will be performed through observations of all communications Following these tests, physicians and COFR staff will be interviewed to assess the new work process and methods as well as the telemedicine mobile app’s strengths and weaknesses. In stage 3, we expect to seek the participation of 10 to 15 pairs of physicians to assess the impact of telemedicine on the quality of case-based discussions and clinical decisions as well as on knowledge transfer. Consultations with medical specialists at the burn unit will be used to estimate the cost of medical procedures, using the physicians’ invoicing manual published by the province’s health insurance authority as a reference
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