 |
|
Authors' Comment
Vivian West, RN, MBA;
Susan Gustke, MD
Arch Fam Med. 2000;9:1040.
There are numerous examples of the benefits of telemedicine for patients and their providers. The 3 cases described below illustrate how telemedicine can facilitate improved access and care for patients.
Case 1
During a routine wellness checkup, an internist in a rural community in eastern North Carolina was examining a 3-year-old boy. He heard a suspicious murmur and knew that a pediatric cardiologist should examine the child. The closest specialist was at East Carolina University (ECU), 70 miles (112 km) away. The boy's father was a Hispanic migrant worker without transportation to the university, so an urgent consultation was scheduled with the Telemedicine Center. The child and his father were seen by telemedicine consultation in the same clinic where the internist examined the boy. Using an electronic stethoscope, the pediatric cardiologist confirmed that the boy had a sinus venosus atrial septal defect (SVD). A radiology van was sent to the rural clinic the following day to obtain an echocardiogram, which was immediately forwarded to the cardiologist via the telemedicine network. Because of the dangerous size of the SVD, the boy was transported by ambulance to ECU, where surgery was performed the next day. Within 1 week, the child was recovering at home. The pediatric cardiologist stated that without the ability to diagnose and quickly intervene, this child might not have survived.
Case 2
In September 1999, eastern North Carolina was devastated by severe flooding from Hurricane Floyd. Four of the 8 emergency shelters were completely cut off from all medical facilities by the overflowing Tar River. To help meet the medical needs of the people who were residing in these shelters and support the volunteer physicians and nurses providing care, the Telemedicine Center configured a low-tech televideo link over an analog telephone line from the shelters to the hospital's emergency department.
One especially poignant situation was that of an 8-year-old boy diagnosed as having cancer. In their haste to escape from encroaching floodwaters, the patient and his family neglected to take the boy's chemotherapy medication with them when they were evacuated from their home. The patient and his mother were to be airlifted from the shelter to the hospital for treatment, leaving behind the patient's grandmother and 3-year-old sibling. This plan caused increased anxiety in all of the family members. To alleviate their angst and prevent family separation during a difficult time, a telemedicine consultation was conducted. The patient's oncologist, the family, and a nurse at the shelter were able to establish a treatment plan that could be managed from the shelter.
Case 3
A small 49-bed rural hospital received 2 gunshot victims who were involved in a family dispute. One patient was a 70-year-old man who presented with a head wound and brain injury; the second patient was a 19-year-old man with chest wounds and a pneumothorax. The hospital was 57 miles (91 km) from the ECU medical center. Hospital staff requested assistance with the patients from the ECU emergency department and trauma team through their telemedicine link. Using the remote-controlled telemedicine camera mounted on the wall between the 2 beds in the rural hospital's emergency room, the trauma surgeons and neurologists from ECU were able to evaluate the severity of injuries of the patient with a head wound and brain injury, and arrange for his emergency transport to ECU. They also directed the primary care physician at the rural hospital in inserting a chest tube in the patient with a pneumothorax. Although both patients had life-threatening injuries, the small staff in the rural hospital's emergency room were able to provide adequate care to both patients with the assistance of the consultants from ECU.
AUTHOR INFORMATION
We thank Gloria Jones, Telemedicine Program Manager at the Center for Health Sciences Communication at East Carolina University Brody School of Medicine, who provided suggestions for the 3 cases described above.
Greenville, NC
RELATED ARTICLE
Profile of Users of Real-Time Interactive Teleconference Clinical Consultations
Susan Gustke, David C. Balch, Lance O. Rogers, and Vivian L. West
Arch Fam Med. 2000;9(10):1036-1040.
ABSTRACT
| FULL TEXT
|
