No abstract

Many telemedicine projects fail to survive beyond the funded research phase. A review of seven Scottish telemedicine services was conducted to identify successes and failures. Qualitative interviews were conducted with key individuals in each project. All projects were partly successful. The main reasons associated with partial failure were: the service was not needs-driven; there was no commitment to provide the service; there was no suitable exit strategy after research funding expired; there was poor communication; there was a lack of training; there were technical problems; work practices were not updated; the protocols for use were poor or non-existent. Based on this, guidelines that might improve the chances of success in future projects were drawn up.

The editors have tried to ensure the accuracy of this report but cannot accept responsibility for any errors or omissions. They would like to thank the referees for their constructive comments on the draft document.

A retrospective study was carried out on medical evacuations from the installations of four major oil or gas producing companies, or both, operating offshore on the United Kingdom continental shelf. The study covered 1976-84 during which 2162 evacuations were recorded. Of these, 137 (7-7%) required the use of a chartered helicopter. In the earlier years of the study there were substantially more injuries sustained than episodes of illness recorded but from 1980 onwards the cases of illness equalled those of injury. Using the International Classification of Diseases, the digestive system was responsible for most evacuations for illness and of those, about half (115 evacuations) were for dental problems. Suspected fractures were responsible for about one third of those evacuated for an injury but injuries of hands and eye conditions were particularly common, accounting for 25% of all evacuations. As the age of the evacuee increased the proportion of evacuations for injury decreased and that for illness increased. The mean age for evacuation for injury was 28-3 years and for illness 34-4 years. Few evacuations were required for those aged over 45.

We evaluated an accident and emergency teleconsultation service provided to 14 community hospitals in north-east Scotland. Each community hospital was equipped with a videoconferencing system and a document camera to allow transmission of radiographs. The network used 384 kbit/s ISDN connections. A total of 1392 teleconsultations were recorded during a 12-month study period. Seventy-seven per cent of patients (n = 1072) were managed locally and 23% (n = 320) were transferred to Aberdeen. The majority (95%) of teleconsultations were conducted on weekdays, and 90% of these occurred between the hours of 09:00 and 16:00. The mean delay in contacting a doctor was 9 min and the mean consultation time was 10 min. The majority of patients were suffering from fractures or suspected fractures of the limbs. Radiograph transmission was used in 75% of all teleconsultations. A high degree of satisfaction was recorded by all users of the service.