Teleneurology by email

Abstract

We introduced an email teleneurology service for patients referred to a neurologist by general practitioners. Over 14 months, 76 referrals (of 75 patients) were received. To determine the sustainability of the service, we studied a second cohort of 76 consecutive patients referred after our first study. We also followed up the first cohort of patients to get information on longer-term safety. The second cohort was obtained in one month less than the first, and had similar characteristics in terms of age, sex and the time taken by the neurologist to reply to the general practitioner. It contained fewer patients requiring clinic appointments (34% versus 43%). Fewer patients from the second cohort were referred for second opinions (4 versus 10) and there were no resulting changes in diagnosis. Follow-up of the first cohort from a mean of 6 months to a mean of 23 months led to seven more re-referrals and no additional changes in diagnosis. We conclude that teleneurology by email is sustainable for this group of patients, and confirm that it is safe, effective and efficient.

Email triage is an effective, efficient and safe way of managing new referrals to a neurologist

“…The system is that described in previous studies 3 4. GPs refer by email using a specially designed one-page template.…”

Smoothing the passage of patients from primary care to specialist respiratory opinion

“…20,21 Many specialties have produced and promoted standardised referral letters, guidelines and referral criteria, plus or minus specific education for GPs, 2,14,26,27,32 as a means to improve referral information. There has been some success with the use of structured forms; 15,16 however, the results are equivocal 19 and passive dissemination of guidelines has not been found to be an effective strategy to improve referral information. 2,11,13,33,34 Additionally, this approach leads to an unwieldy proliferation of national and local guidelines.…”

“…Systems which permit specialist history-taking by telephone, e-mail or letter have potential, although each is subject to limitations imposed by patient characteristics as well as access to, and comfort with, the technologies. 42 The use of e-mail to facilitate triage and diagnosis has been successfully piloted in neurology 15 and telephone consultations are already a common feature of primary and secondary care services in a large number of healthcare systems. [43][44][45] Further study is now required to evaluate their effects on the management of new referrals and to determine which best facilitates a more streamlined process and patient-centred experience.…”

“…Twenty-four studies were identified, covering a wide range of specialties [1][2][3][4][5][6][7] and different referral systems. [8][9][10] Several evaluated the impact of guidelines [11][12][13][14] or use of structured referral forms 15,16 on referral information. Although the review provided some international diversity, [17][18][19][20] …”

Remote care of a patient with stroke in rural Trinidad: use of telemedicine to optimise global neurological care

“…Teleneurology consultations has been successfully used via email between two countries such as UK and Bangladesh 33. Teleneurology by email is considered sustainable, safe, effective and efficient 34. It has demonstrated clinical effectiveness in increasing access to neurological expertise, reducing patient and physician travel time, fostering communication and coordinated care and improving physician productivity.…”