Télécharger le rapport (152 p.) - KCE

94 Urgences KCE reports vol. 19B
FIRST AUTHOR-
YR-CTRY.
SHEPPERD S.-
2001-UK.
TACHAKRA S.-
2000-UK.
TACHAKRA S.-
2002-UK.
VAN HOECK
K.-2002-BEL.
TYPE STUDY OBJECTIVE(S) METHOD(S) RESULTS DISCUSSION
Cochrane based
systematic
review.
Wide ranging
view study.
Case control
study.
Report about a
pilot project in a
defined area.
Assessing the hospital at home versus
in-patient hospital care.
Describing and arguing the different
models of telemedicine,the possible
dispositions of services.
Accuracy and reliability of
teleconsultations (radiographs) in a
minor injury unit one year(casual use)
and over a 4 yr period afterwards.
Studying a common organisation of
duty primary and secondary
emergency services.
Systematic selection of the randomized
trials, using the Cochrane effective
practice and organisation of care grp.
and extraction of data- assessing study
quality by 2 reviewers.
Reasons, technological advances,
disposition of the useful potential users,
subjected to double peer review.
Over the 4 yrs 3,6 % of consults (mainly
fractures,infections,less chest pain) were
performed with telemedicine. Half of the
cases were done by reason of
teleradiology for fractures. Image clarity
was judged satisfactory in 88 %; sound
clarity in 77%.
Stepwise approach of a task sharing
between GPCO and GP rotasystems and
EDÊs in the region of Leuven-BE.
16 trials retained. No different patient outcomes
for elderly pats with a mix of medical conditions
and pats recovering from elective surgery. More
conflicting are these recovering from stroke.
more independence at home but less
psychosocial communication, pats prefer home
hospital and carers the opposite, more length of
treatment in the hospital at home grp.
Additional peripherals (fe. Electronic
gloves,multidimensional
oftalmoscopes..),automatic call redirection and
instruction for further investigation,pattern
recognition for diagnostics(ECG), automatic
teaching,fasrer links are recnet applicable
tecnological advances in telemedicine.
Telemedicine needs additional training especially
for nurses specialising in this new field.·
Telemedicine can save a referral to ED in 90 % of
bone injuries and infections.·Telemedicine
reduces significantly the workload of GPÊs and
EDÊs..
10 key messages are addressed to fullfill an
optimal task description of the different levels of
emergency care dealing with PC
centres,infochannels, public awareness, modern
technology, unsafety, inclusion of other
paramedicals, financial subsidies.
This review donÊt support the
hospital at home services as
cheaper than in-patient
care.Future research will hav
eto focus on admission
avoidance schemes,and the
effect of early discharge
hospital at home schemes for
pats recovering from a stroke.
The telemedicine can be used
by GPCOÊs,chemists, NHS
direct,paramedic
management,walk-in centres,
minor injury units,emergency
rooms and ambulances,senior
consultants in residnece in
secondary hospitals.
Telemedicine is an excellent
educational tool and the
spectrum of cases that Enurses
see has been enlarged
and their practical skill
extended.
This practical guidelines are a
interesting and novative
initiative to enhance the
better compliance between
emergency PC and SC to be
replicable across teh borders.