Impact of knowledge transfer through the implementation of a telemedicine program in a community hospital in Brazil

Abstract

Introduction Emergency survival rates vary significantly according to the quality of care, which depends on human and technological resources. Emergency and critical care medicine physicians must make fast decisions; the presence of experienced consultants improves survival. In developing countries, there is a shortage of skilled doctors. The aim is to describe the first Brazilian initiative of realtime teleconferencing telemedicine (TM) providing 24/7 emergency department (ED) and ICU coverage. Methods Since May 2012 a TM program has been implemented at two hospitals in São Paulo, Brazil -Hospital Municipal Dr. Moysés Deutsch (HMMD), a public, secondary hospital, and Hospital Israelita Albert Einstein (HIAE), a tertiary private philanthropic entity -due to a partnership with the Brazilian Health Ministry. TM Central Command was located at HIAE with Endpoint 97 MXP Cisco® Solution and a mobile Intern MXP ISDN/IP Cisco® for the remote hospital (HMMD) via dedicated GB/sec connection. Imaging examinations were evaluated using PACS technology. Every recruited patient was assessed by the Central Command through TM with an experienced consultant. Results Over a 6-month period, 131 teleconsultations (114 patients) were done. Mean age was 50.1 years, 57.1% was male and mean APACHE II score was 24.3. A total of 64.8% originated from the ICU and 35.2% from the ED. Main consultation diagnoses were sepsis (31.3%); stroke (29.8%); survival from cardiac arrest (6.1%); trauma (6.1%); and acute myocardial infarction (5.3%). TM improved diagnosis in 14.5% and influenced the clinical management in 85.5% of the consultations. Invasive procedures were indicated in 61.1%. Life-saving procedures were TM related in seven patients (6.1%): stroke thrombolysis (n = 6) and limb amputation (n = 1). Seven patients (6.1%) were transferred and submitted to surgical procedures (heart surgery (n = 2), neurosurgery (n = 4) and liver transplantation (n = 1)). The majority of the patients remained at HMMD and were discharged. Conclusion A TM program is feasible to be implemented in a community hospital. The major benefit is expertise medical transfer from the tertiary hospital to the community setting, improving diagnosis and management of critical care patients, and avoiding routine transfer to a major urban center.