Teleradiology for remote consultation using iPad improves the use of health system human resources for paediatric fractures: prospective controlled study in a tertiary care hospital in Italy

BMC Health Services Research

Marzia Lazzerini²  Francesca Vittoria¹  Daniela Dibello¹  Valentina Di Carlo¹  Luca Odoni¹  Marta Marini³  Riccardo Fascetta³  Daniele Grosso²  Floriana Zennaro³ 

[1] Departments of Orthopaedics, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy;Unit Of Research on Health Services and International Health, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy;Departments of Radiology, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy

关键词: Cost;    Organisation of care;    Fractures;    Children;    Teleradiology;   

Others  :  1126832
DOI  :  10.1186/1472-6963-14-327

 received in 2014-03-06, accepted in 2014-07-16,  发布年份 2014

【 摘 要 】

Background

The growing cost of health care and lack of specialised staff have set e-Health high on the European political agenda. In a prospective study we evaluated the effect of providing images for remote consultation through an iPad on the number of in-hospital orthopaedic consultations for children with bone fractures.

Methods

Children from 0 to 18 years diagnosed with a bone fracture by the radiologist during the hours when an orthopaedic service is provided only on-call were eligible for enrollment. Cases were enrolled prospectively during September and October 2013. A standard approach (verbal information only, no X-Ray provided remotely) was compared to an experimental approach (standard approach plus the provision of X-ray for remote consultation through an iPad). The primary outcome was the number of orthopaedic in-hospital consultations that occurred. Other outcomes included: immediate activation of other services; time needed for decision-making; technical difficulties; quality of images and diagnostic confidence (on a likert scale of 1 to 10).

Results

Forty-two children were enrolled in the study. Number of in-hospital consultancies dropped from 32/42 (76.1%) when no X-ray was provided to 16/42 (38%) when the X-rays was provided (p < 0.001). With remote X-ray consultation in 14/42 (33.3%) cases services such as surgery and plaster room could be immediately activated, compared to no service activated without teleradiology (p < 0.001). Average time for decision making was 23.4 ± 21.8 minutes with remote X-ray consultation, compared to 56.2 ± 16.1 when the X-ray was not provided (p < 0.001). The comparison between images on the iPad and on the standard system for X- Ray visualisation resulted in a non statistically significant difference in the quality of images (average score 9.89 ± 0.37 vs 9.91 ± 0.30; p =0.79), and in non statistically significant difference in diagnostic confidence (average score 9.91 ± 0.32 vs 9.92 ± 0.31; p = 0.88).

Conclusions

Remote X-ray consultation through Aycan OsiriX PRO and iPad should be considered as a means for reducing the need of in-hospital orthopaedic consultation during on-call times, and potentially decrease the cost of care for the health system. In the future, alternative systems less expensive than Aycan OsiriX PRO should be further developed and tested.

【 授权许可】

   
2014 Zennaro et al.; licensee BioMed Central Ltd.

【 图 表 】

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