Clinical telemedicine : the development and introduction of an accident and emergency teleconsultation service for North East Scotland
Introduction: A joint grant application, lead by the University of Aberdeen and the National Health Service Grampian, was successful in securing £1.1million pounds from the Scottish Executive, Health Department. The grant funding was for the establishment of a national pilot telemedicine network in Scotland. The purpose of the network was to provide an accident and emergency teleconstruction service to community hospitals based in the northeast of Scotland. The establishment of this service allowed several academic studies to be completed. Aims of the thesis: to conduct a systematic review of peer reviewed publications describing the use of accident and emergency teleconsultations for primary care. The review examines technical feasibility, clinical effectiveness, cost effectiveness and user satisfaction; To develop, deliver and evaluate a training course for telemedicine users involved in accident and emergency teleconsultations; To introduce and evaluate an accident and emergency teleconsultation service; To produce guidelines for the introduction of future clinical telemedicine services. Systematic Review: Thirty one papers were selected for review. The results indicated that accident and emergency teleconsultations were technically feasible, clinically effective and produced a high degree of user satisfaction. There was a lack of evidence to demonstrate that these teleconsultations were cost effective. Training: Before establishing a telemedicine service the following steps were identified as being important: identifying the required training competencies; Delivering a "hands on" training programme based on the required training competencies; Reinforcing the training programme with an instruction booklet; Ensuring that trainees have at least weekly practice; Measuring the level of user competence. Evaluation: The present study suggests that: A telemedicine service must be needs driven; The workload must be sufficient to maintain the skill and confidence levels of the staff who use the service; There must be a commitment, at the main centre, to service provision; Telemedicine 'champions' should be identified and encouraged; Clear telemedicine protocols must be produced and distributed; Both the equipment and the communication infrastructure must be reliable; The equipment must be 'user-friendly'; Training must be given to establish and maintain user competence; The staffing and training implications of treating patients locally instead of sending them to the main centre must be addressed; The service must be objectively evaluated. Guidelines: Based on the information provided by the study, a series of guidelines have been produced. These guidelines are suitable for use by any individual or group in seeking to implement a clinical telemedicine service.