Table 1

Minor injuries telemedicine projects reported between 1994 and 1999

Date startedConsulting minor injuries unitSupporting A&E departmentNumber of patients using telemedicineMain findingsMain weaknesses
199426South Westminster Health Centre, LondonRoyal Victoria Hospital, Belfast511 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.
199427Peterhead Community Hospital, PeterheadAberdeen Royal Infirmary, Aberdeen1201 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.
199529Three “rural spoke sites” in North DakotaBismark, North Dakota, USA45 (also an overlapping series of 100 “trauma” patients)301 Three quarters of emergency consultations were for trauma, and 96% required the transmission of a radiograph; mainly peripheral limb films1 No control group.
2 53% of patients did not need transfer for further care2 No economic comment made
3 Consultations lasted an average of 3.5 minutes.
19968Wembley Community Hospital, LondonCentral Middlesex Hospital, London1501 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
199734New Jersey, USANew Jersey, USA1041 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