Telemedicine in general neurology: use of audiovisual consultation for on call back-up service in an acute care hospital
While telemedicine is in expanding use in acute stroke care, little is known about its use in general neurology, especially in acute care. We sought to investigate the feasibility and possible effects of a telemedicine device within the neurological back-up service of an acute care hospital.
In a 450 bed academic teaching hospital an experienced neurologist (EN) is on call to support the junior doctor at the hospital. Support was possible whether by standard telephone advice (TA) or by audiovisual consultations (AVC). In AVC the expert used a mobile telemedicine device and so he could establish audiovisual contact from his home to the emergency room and examine newly admitted patients. Technical and patient details including timing and diagnosis were recorded. Video and audio quality as well as impact of AVC on diagnosis was rated by the EN.
Out of about 1200 cases in off peak times, during the study period, 164 AVC including remote video examination were done (13.6%). Also 48 cases were documented by pure TA. Video quality was rated to a medium of 1.7, audio quality to 2.1. In 36 cases the audiovisual consultation was influenced by technical issues leading to cessation of AVC in 8 cases. Duration of teleconsultation was 17.3 min in AVC compared to 8.7 min for TA. The consultation diagnosis in AVC was confirmed in 74.4% of all cases compared to 57.7% in TA. AVC was rated as a valuable contribution to the diagnostic workup in 74.3% of all cases seen. In about 40% of all cases AVC was not possible due to technical or organizational reasons.
Audiovisual consultation seems to be a feasible and useful support in routine neurology back-up service of an acute care hospital. Better mobility of devices and flexibility of service is needed to improve availability and quality of this valuable tool.
KeywordsTelemedicine Teleneurology Clinical neurology
We are very grateful to Sonia Heinloth for proof-reading the manuscript.
Compliance with ethical standards
Sources of funding
The project was funded by the Bavarian State Ministry of Health and Care (DE). There are no restrictions by the funders.
Conflicts of interest
None of the authors has any conflict of interest or any financial relationship to companies or products named in this article. All authors contributed substantially to the manuscript.
The study was conducted according to all common ethical standards including the rules given by the Declaration of Helsinki.
The study was approved by the ethics committee of the University of Erlangen.
All patients participating gave their informed consent prior to inclusion in the study.
- 9.Schwamm LH, Holloway RG, Amarenco P, Audebert HJ, Bakas T, Chumbler NR, Handschu R, Jauch EC, Knight WA 4th, Levine SR, Mayberg M, Meyer BC, Meyers PM, Skalabrin E, Wechsler LR, American Heart Association Stroke Council, Interdisciplinary Council on Peripheral Vascular Disease (2009) A review of the evidence for the use of telemedicine within stroke systems of care: a scientific statement from the American Heart Association/American Stroke Association. Stroke 40:2616–2634CrossRefPubMedGoogle Scholar
- 10.Govindarajan R, Anderson ER, Hesselbrock RR, Madhavan R, Moo LR, Mowzoon N, Otis J, Rubin MN, Soni M, Tsao JW, Vota S, Planalp H (2017) Developing an outline for teleneurology curriculum: AAN Telemedicine Work Group recommendations. Neurology. https://doi.org/10.1212/wnl.0000000000004285 PubMedGoogle Scholar