Table 1

Minor injuries telemedicine projects reported between 1994 and 1999

Date started	Consulting minor injuries unit	Supporting A&E department	Number of patients using telemedicine	Main findings	Main weaknesses
1994²⁶	South Westminster Health Centre, London	Royal Victoria Hospital, Belfast	51	1 During 12 months referrals to A&E and GPs both fell substantially.	1 Historical controls
				2 Use of the telemedical link gradually fell during the study period.	2 Several factors probably responsible for the fall in referral rates
					3 Lack of local knowledge and personal contact reduced the effectiveness of the project in the longer term.
1994²⁷	Peterhead Community Hospital, Peterhead	Aberdeen Royal Infirmary, Aberdeen	120	1 Successful telemedical support to general practitioners working at a remote hospital.	1 Neither a “telepresence” headset nor communication via satellite were found to be useful in this context.
				2 A significant number of patient transfers were avoided by the use of telemedicine.	2 The economic benefits are less clear cut than simply the costs of saved ambulance transfers.²⁸
				3 The project achieved high levels of patient and doctor satisfaction.
1995²⁹	Three “rural spoke sites” in North Dakota	Bismark, North Dakota, USA	45 (also an overlapping series of 100 “trauma” patients)³⁰	1 Three quarters of emergency consultations were for trauma, and 96% required the transmission of a radiograph; mainly peripheral limb films	1 No control group.
				2 53% of patients did not need transfer for further care	2 No economic comment made
				3 Consultations lasted an average of 3.5 minutes.
1996⁸	Wembley Community Hospital, London	Central Middlesex Hospital, London	150	1 Most consultations were related to radiographs.	1 Study not randomised
				2 Remote ENPs can be effectively supported through the use of comprehensive protocols and a minor injuries telemedicine system.	2 No economic comment made
				3 Three month follow up of 99% of the 150 patients managed using telemedicine revealed no changes in diagnosis or further problems. In contrast 1% of those patients treated at the MATS without telemedical support had sought further medical advice
				4 A&E consultants interpreting radiographs as part of a teleconsultation performed better than the consultant radiologist who subsequently reviewed the original films
1997³⁴	New Jersey, USA	New Jersey, USA	104	1 Randomised, controlled clinical trial.	1 Small sample size with low power.
				2 No significant differences were found in return visits within 72 hours, need for additional care, patient and carer satisfaction or time spent in the emergency department.	2 Only 85% follow up achieved.
					3 Four patients in the experimental group who did not complete the study protocol were excluded from analysis