Fracture diagnostics, unnecessary travel and treatment: a comparative study before and after the introduction of teleradiology in a remote general practice.

Jac Jwm Jacobs,Eric Van Sonderen,Thys Van Der Molen,Robbert Sanderman,Jan Pam Jacobs

doi:10.1186/s12875-015-0268-z

Jac Jwm Jacobs, Eric Van Sonderen + Show 3 more

Open Access

https://doi.org/10.1186/s12875-015-0268-z

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Abstract

BackgroundTeleradiology entails attainment of x-rays in one location, transfer over some distance and assessment at another location for diagnosis or consultation. This study documents fracture diagnostics, unnecessary trips to the hospital, treatment and number of x-rays for the years 2006 and 2009, before and after the introduction of teleradiology in a general practice on the island of Ameland in the north of the Netherlands.MethodsIn a retrospective, descriptive, observational before and after study of the introduction of x-ray facilities in an island-based general practice, we compared the number of accurately diagnosed fractures, unnecessary trips, treatments and number of x-rays taken in 2006 when only a hospital x-ray facility was available 5 hours away with those in 2009 after an x-ray facility became available at a local general practice. All patients visiting a general practice on the island of Ameland in 2006 and 2009 with trauma and clinical suspicion of a fracture, dislocation or sprain were included in the study. The initial clinical diagnoses, including those based on the outcomes of x-rays, were compared for the two years and also whether the patients were treated at home or in hospital.ResultsA total of 316 and 490 patients with trauma visited a general practice in 2006 and 2009, respectively. Of these patients, 66 and 116 were found to have fractures or dislocations in the two years, respectively. In 2006, 83 x-rays were ordered; in 2009, this was 284. In 2006, 9 fractures were missed; in 2009, this was only 2. In 2006, 15 patients with fractures or dislocations were treated at the general practice; in 2009, this had increased to 77.ConclusionSince the introduction of teleradiology the number of missed fractures in patients visiting the general practice with trauma and the number of the unnecessary trips to a hospital are reduced. In addition more patients with fractures and dislocations can be treated in the general practice as opposed to the hospital.

Highlights

Teleradiology entails attainment of x-rays in one location, transfer over some distance and assessment at another location for diagnosis or consultation
Medical care is delivered at two general practices, which in cases of emergencies serve the function of emergency room
In 2006 and 2009, respectively, 316 and 490 patients visited the general practice with recent traumas

Summary

Introduction

Teleradiology entails attainment of x-rays in one location, transfer over some distance and assessment at another location for diagnosis or consultation. This study documents fracture diagnostics, unnecessary trips to the hospital, treatment and number of x-rays for the years 2006 and 2009, before and after the introduction of teleradiology in a general practice on the island of Ameland in the north of the Netherlands. Teleradiology is the electronic transmission of radiological images from one location to another for the purpose of interpretation and/or consultation. This technique has proliferated in many countries but not yet in the Netherlands [1]. In the Netherlands, an average of 42–43 per 1000 patients experience new traumas and visit a general practice annually: 27 with strains on average; 13–14 with fractures on average; and 2 with dislocations on average [4]. Trauma patients with suspected strains, in contrast, are typically treated only on the basis of clinical signs by general practitioner

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