Journal article
Emergency department telemedicine consults decrease time to interpret computed tomography of the head in a multi-network cohort
Journal of telemedicine and telecare, Vol.27(6), pp.343-352
07/2021
DOI: 10.1177/1357633X19877746
PMCID: PMC7196443
PMID: 31684801
Abstract
Introduction
Telemedicine can improve access to emergency stroke care in rural areas, but the benefit of telemedicine across different types and models of telemedicine networks is unknown. The objectives of this study were to (a) identify the impact of telemedicine on emergency department (ED) stroke care, (b) identify if telemedicine impact varied by network and (c) describe the variation in process outcomes by telemedicine across EDs.
Methods
A prospective cohort study identified stroke patients in four telemedicine networks between November 2015 and December 2017. Primary exposure was telemedicine consultation during ED evaluation. Outcomes included: (a) interpretation of computed tomography (CT) of the head within 45 minutes and (b) time to administer tissue plasminogen activator (tPA). An interaction term tested for differences in telemedicine effect on stroke care by network and hospital.
Results
Of the 932 stroke subjects, 36% received telemedicine consults. For subjects with a last known well time within two hours of ED arrival (27.9%), recommended CT interpretation within 45 minutes was met for 66.8%. Telemedicine was associated with higher odds of timely head CT interpretation (adjusted odds ratio = 3.03; 95% confidence interval (CI) 1.69–5.46). The magnitude of the association between telemedicine and time to interpret a CT of the head differed between telemedicine networks (interaction term p = 0.033). Among eligible patients, telemedicine was associated with faster time to administer tPA (adjusted hazard ratio = 1.81; 95% CI 1.31–2.50).
Discussion
Telemedicine consultation during the ED encounter decreased the time to interpret at CT of the head among stroke patients, with differing magnitudes of benefit across telemedicine networks. The effect of heterogeneity of telestroke affects across different networks should be explored in future analyses.
Details
- Title: Subtitle
- Emergency department telemedicine consults decrease time to interpret computed tomography of the head in a multi-network cohort
- Creators
- Morgan B Swanson - Department of Epidemiology, Colleges of Medicine and Public Health, University of Iowa, Iowa City, IA, USAAspen C Miller - Department of Emergency Medicine, University of Iowa, Iowa City, IA, USAMarcia M Ward - Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, IA, USAFred Ullrich - Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, IA, USAKimberly AS Merchant - Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, IA, USANicholas M Mohr - Department of Anesthesia, Division of Critical Care, University of Iowa, Iowa City, IA, USA
- Resource Type
- Journal article
- Publication Details
- Journal of telemedicine and telecare, Vol.27(6), pp.343-352
- DOI
- 10.1177/1357633X19877746
- PMID
- 31684801
- PMCID
- PMC7196443
- NLM abbreviation
- J Telemed Telecare
- ISSN
- 1357-633X
- eISSN
- 1758-1109
- Publisher
- SAGE Publications
- Grant note
- UICRH29074 / Federal Office of Rural Health Policy (https://doi.org/10.13039/100010001) K08 HS025753 / Agency for Healthcare Research and Quality (https://doi.org/10.13039/100000133)
- Language
- English
- Date published
- 07/2021
- Academic Unit
- Rural Telehealth Research Center; Health Management and Policy; Epidemiology; Emergency Medicine; Orthopedics and Rehabilitation; Anesthesia; Injury Prevention Research Center
- Record Identifier
- 9984221750602771
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