JMIR Publications

ABSTRACT

Background:

Telehealth is a recognized and rapidly evolving domain in the delivery of emergency medicine. Research suggests a positive impact of telehealth for patients presenting for emergency care, however, the regional challenges of acute telemedicine delivery have not been studied. The WA Country Health Service (WACHS) established the Emergency Telehealth Service (ETS) in 2012 to provide telehealth and other technology enabled services to regional Western Australian hospitals and clinics. The WACHS ETS supports 87 rural and remote WACHS-operated hospitals as well as 10 non-WACHS health clinics via high-definition audio-visual equipment installed in the resuscitation bay of each sites’ emergency department (ED). This 12-year practical application of emergency telemedicine offers a unique opportunity to explore the experiences and perceptions of clinicians delivering virtual care to rural and remote communities.

Objective:

This study explores the ETS clinician’s perceptions relating to the acceptability, appropriateness and clinical decision making when delivering emergency telehealth in the rural and remote setting.

Methods:

This qualitative study used semi-structured interviews to explore ETS clinicians’ perspectives on factors influencing their clinical decision making. It explored how ETS clinicians determine and modify clinical risks associated with using audio-visual equipment to deliver care. Emerging themes were compared with the concepts arising from the interim guidance from the Medical Board of Australia, and both the Australian and New Zealand, and the American Colleges of Emergency Medicine.

Results:

Sixteen doctors, four clinical nurse coordinators and a nurse educator from WACHS ETS gave their experience and perspectives. Accurate clinical decisions, especially regarding patient disposition, were crucial to virtual care. Timeliness and accuracy were enhanced through a mutual learning model grounded in the local context. Mitigation strategies like improvisation and flexible technology use compensated for technological barriers. Non-modifiable risk factors included patients’ presenting complaint, clinical urgency of presentation, ED capability, clinician scope of practice, and if transfer was required, the distance between ED of original presentation to the hospital of definitive care.

Conclusions:

Telehealth can enhance clinical decision-making in rural and remote EDs, and ETS clinicians prioritized patient safety through a lens incorporating both local hospital capabilities and community contexts. Even for the most experienced clinicians, telehealth was not comparable to face-to-face communication in all circumstances. The impact of ETS on the scope of regional Emergency Medicine (EM) practice and in the building of clinical skills warrants further study in relation to its overall effectiveness and cost-effectiveness in rural and remote EDs. These findings identify areas for further qualitative research while providing rich contextual background for rigorous quantitative analysis on ETS effectiveness.