Telemedicine Is Associated with Faster Diagnostic Imaging in Stroke Patients: A Cohort Study.
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BACKGROUND Meeting time goals for patients with time sensitive conditions can be challenging in rural emergency departments EDs and adopting policies is critical ED based telemedicine has been proposed to improve quality and timeliness of care in rural EDs INTRODUCTION The objective of this study was to test the hypothesis that diagnostic testing in telemedicine supplemented ED care for patients with myocardial infarction MI and stroke would be faster than nontelemedicine care in rural EDs MATERIALS AND METHODS This observational cohort study included all ED patients with MI or stroke in 19 rural critical access hospitals served by a single real time contract based telemedicine provider in the upper Midwest 2007 2015 The primary outcome for the MI cohort was time to electrocardiogram EKG and for the stroke cohort was time to head computed tomography CT interpretation To measure the relationship between telemedicine and timeliness parameters generalized estimating equations models were used clustering on presenting hospital RESULTS Of participating ED visits 756 were included in the MI cohort 29 used telemedicine and 140 were included in the stroke cohort 30 used telemedicine Time to EKG did not differ when telemedicine was used 1 faster 95 confidence interval CI 4 to 7 or after telemedicine was implemented 4 faster 95 CI 3 to 10 Head CT interpretation was faster for telemedicine cases 15 faster 95 CI 4 26 No differences were observed in time to reperfusion therapy CONCLUSIONS Telemedicine implementation was associated with more timely head CT interpretation for rural patients with stroke but no difference in early MI care Future work will focus on the specific manner in which telemedicine changes ED care processes and ongoing professional education