Impact of Knowledge Transfer Through the Implementation of an Emergency Telemedicine Program in a Brazilian Community Hospital

摘要

Variation of quality care has been associated with heterogeneous survival rates among emergency and critical care patients. A body of evidence has shown that emergency and ICU physician-led team could deliver a more adequate care and decrease mortality rates and costs. In developing countries there is a shortage of specialists even in metropolitan areas. The main objective of this study is to describe the first Brazilian experience of a real time audio-visual telemedicine program (TM) providing 24/7 emergency and Intensive Care physicians' coverage. Methods: The concept of telemedicine was implemented at two different hospitals in Sao Paulo; a secondary and public hospital, Hospital Municipal Moyses Deutsch (HMMD), and a tertiary and private hospital, Hospital Israelita Albert Einstein (HIAE). Results: Data were obtained from 100 teleconsultations (85 patients) records over a 4 months period. The majority of the requests originated from ICU (74.1%). Sepsis was the most common reason to access TM (29.4%), followed by stroke (24.7%). TM improved diagnosis in 16.5% and influenced clinical management in 83.5% of the patients. Life-saving TM interventions were stroke thrombolysis in 4 patients and a limb amputation in 1 patient. The majority of patients was discharged with no necessity of referring to another hospital. Conclusion: We conclude that the main contribution of telemedicine-based intervention is to avoid unnecessary transfers and to improve medical decision-making in a real time fashion.