du Toit, Marie, Malau-Aduli, Bunmi, Vangaveti, Venkat, Sabesan, Sabe, and Ray, Robin A. (2019) Use of telehealth in the management of non/critical emergencies in rural or remote emergency departments: a systematic review. Journal of Telemedicine and Telecare, 25 (1). pp. 3-16.

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Abstract

Background: Telehealth has been used extensively in Emergency Departments to improve healthcare provision. However, its impact on the management of non-critical emergency presentations within rural and remote ED settings has not been adequately explored. The objective of this systematic review is to identify how telehealth has been used to assist in the management of non-critical presentations in rural and remote emergency departments and the outcomes.

Methods: Articles were identified through database searches of CINAHL, Cochrane, MEDLINE(OVID), Informit and SCOPUS, as well as screening of relevant article reference and citation lists. To determine how telehealth can assist in the management of non-critical emergencies. Information was extracted relating to telehealth program model, the scope of service and participating health professionals. The outcomes of telehealth programs were determined by analysing the uptake and usage of telehealth, the impact on altering diagnosis or management plan as well as patient disposition including patient transfer, discharge, local hospital admission and rates of discharge against medical advice.

Results: Of the 2532 identified records, fifteen were found to match the eligibility criteria and were included in the review. Uptake and usage increased for telehealth programs predominantly utilised by nursing staff with limited local medical support. Tele-consultation conservatively altered patient diagnosis or management in 18-66% of consultations. Although teleconsultation was associated with increased patient transfer rates, unnecessary transfers were reduced. Simultaneously, an increase in local hospital admission was noted and less patients were discharged home. Discharge against medical advice rates were low at 0.92-1.1%.

Conclusion: The most widely implemented hub-and-spoke telehealth model could be incorporated into existing referral frameworks. Telehealth programs may assist in reducing unnecessary patient transfer and secondary overtriage, while increasing the capacity of ED staff to diagnose and manage patients locally, which may translate into increased local hospital admission and reduced discharge rates following teleconsultation.

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