Cross-sectional Study of the Ambulance Transport Between Healthcare Facilities With Medical Support via Telemedicine: Easy, Effective, Low-cost, and High-security Tool

Abstract

Background: Feasibility and safety of ambulance transport between healthcare facilities with medical support exclusively via telemedicine is unknown. Methods: This was a retrospective study with a single telemedicine center reference for satellite emergency departments of the same hospital. 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. For inclusion, the criteria demanded the patients above the age of 15 years and initial stabilization be performed at the emergency department. Unstable, intubated, ST-elevation myocardial infarction, and acute stroke patients were excluded. The primary endpoint was the number of telemedicine-guided interventions during transport. Results: 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 main remotely-oriented interventions. There were no communication problems in the telemedicine-assisted group. Conclusions: Telemedicine-assisted ambulance transportation of stabilized critically ill patients can effectively and safely substitute an onboard physician on most transfers between same-institution locations.