Systematic review of telemedicine applications in Emergency Rooms

Background: Despite the frequency of use of telemedicine in emergency care, limited evidence exists on its impacts at the patient, provider, organization, and system level. Hospital-based applications of telemedicine present a potentially important solution, particularly for small and rural hospitals where access to local specialists is rarely available.

Purpose: We conducted a systematic review of telemedicine applications for hospital-based emergency care, which aims to synthesize the existing evidence on the impacts of tele-emergency applications that could inform future efforts and research in this area.

Methods: A search of four databases (PubMed, CINAHL, EMBASE, Cochrane) using a combination of telemedicine and emergency room keywords for publications yielded 340 citations. Four coders independently determined eligibility based on initial criteria and then extracted information on the 38 resulting articles based on four main categories: study setting, type of technology, research methods, and results.

Results: Of the 38 articles, 11 studies focused on telemedicine for diffuse patient populations that typically present in emergency rooms (ERs), 8 studies considered telemedicine in the context of minor treatment clinics for patients presenting with minor injuries or illnesses, and 19 studies focused on the use of telemedicine to connect providers in ERs to specialists for consultations on patients with specific conditions. Consistently, tele-emergency studies reported positive findings especially in terms of technical quality and user satisfaction. There were also positive findings reported for clinical processes and outcomes, throughput, and disposition. Studies of economic outcomes are particularly limited.

Conclusions: The body of studies on tele-emergency indicate an application that meets the needs of small and rural hospitals to address infrequent but emergency situations requiring specialist care. Similarly, studies indicate that tele-emergency has considerable potential to facilitate the use of remote areas clinics while relieving the demand on urban ERs.