Operations and Implementation
EP-140 - Telemedicine-Assisted Transportation of Critically Ill Patients Between Same-Institution Locations
Monday, April 30
4:05 PM - 4:20 PM
Location: Education Zone, Booth 2416, Screen 3
Transportation of critically ill patients between hospital locations usually requires a highly-specialized ambulance team, including a trained driver, paramedics and a medical doctor. However, keeping a physician available to assist on that type of transportation is expensive, expanding idleness and occupational hazard.
This e-poster intends to present a full-scale live video telemedicine service to assist critically-ill patient transportation between same-institution locations and was developed by the Hospital Israelita Albert Einstein Telemedicine Center. Considered one of the best hospitals in Latin America, Hospital Israelita Albert Einstein is a 650-bed high complexity general hospital located in the city of São Paulo, the largest and most populous city in Brazil as well in the southern hemisphere.
Albert Einstein has four full-equipped satellite emergency department locations distant 5 to 15 miles from the main building. All patients requiring hospital admission should be transported to the main building. Due to heavy traffic, even with ambulance priority, transfer duration can easily reach more than one hour. Under these conditions the potential need of medical intervention or complications during the conveyance increases.
However, since after medical evaluation and treatment most patients requiring admission to a semi-intensive or intensive care unit are already stable at those locations, selected low-risk cases could be suitable to be transported under telemedicine-assisted supervision by a physician. As a result, a single doctor can be available to assist multiple transportations without the need to be onboard, reducing idleness and optimizing costs without compromising patient safety.
Therefore, a protocol was designed to select patients with lower risk of transportation, mainly excluding those considered unstable, needing advanced respiratory support and/or vasoactive agents. Also, STEMI and acute stroke patients were also excluded from telemedicine-only supervision transportation. Selected patients were transported by a trained paramedic, connected through 4G broadband internet connection on an onboard tablet device, under live video supervision by a staff physician at the hospital.
Over the first six months of 2017 there were 766 critically-ill patient transportation between distant emergency departments and the main building, 606 (79%) of which were assigned to medical supervision by telemedicine. That figure represents roughly a 30% reduction in transportation costs. Medical intervention has been needed on only 1% of the cases, all of which considered safe to be done under supervision at a distance. There were no severe adverse events reported nor technological malfunction/loss of signal reports (it's a highly-urbanized area). Therefore, transportation of selected low-risk critically-ill patients under physician supervision by telemedicine can be considered safe and feasible. A continuing analysis of the results is being carried on, and a thorough cost-benefit analysis is under investigation.
- implement a telemedicine solution to assist critically-ill patient transportation by ambulance for short distances
- design a protocol to select patients suitable to transportation assisted by telemedicine, replacing the need for an onboard physician
- understand most common caveats in the implementation of a telemedicine-assisted transportation system