JMIR Publications

ABSTRACT

Background:

Telemedicine has transformed healthcare delivery by improving access to specialized care and reducing costs. While its efficacy has been established in critical care, emergency services, and chronic disease management, its application in highly critical anesthesia settings remains underexplored. In anesthesiology, telemedicine has shown promise in preoperative evaluations, intraoperative monitoring, and postoperative follow-up, yet a universal, standardized tele-supervision solution for the operating room (OR) is lacking.

Objective:

This study aimed to evaluate a novel telemedical supervision system for critical anesthetic scenarios in a simulated OR environment, comparing it to traditional on-site supervision. Specifically, adherence to standard operating procedures (SOPs), number and modality of senior physician contacts, workload, and user perceptions were assessed.

Methods:

In this randomized controlled simulation study, 16 anesthesiology residents (within their first two years of training) from the University Hospital Uniklinik RWTH Aachen (Germany) were randomized using block randomization into two groups. The intervention group received remote support via a tele-supervision system exclusively, while the control group used a conventional phone with on-site support. The telemedical system comprised an anesthesia workstation (AN-WS) that integrated data from patient monitor, anesthesia device, and syringe pumps using the IEEE 11073 SDC standard, and a mobile supervision workstation (SV-WS) that enabled the senior physician to monitor multiple ORs and communicate via text, audio, and video. The simulated scenario involved a 51-year-old male patient undergoing an appendectomy who developed an anaphylactic reaction three minutes after receiving Cefuroxime. Primary outcomes focused on the completion rate of necessary SOP measures. Secondary outcomes included the workload measured using the NASA Task Load Index (TLX), and participants' post-scenario questionnaire responses. Statistical comparisons were performed using Welch’s t-test.

Results:

All participants in both groups contacted the senior physician at least once. The control group averaged 6.44 SOP measures that were supported, whereas the intervention group averaged 5.00. The mean SOP completion rate was 92.5% (IQR: 88.9%–94.7%) in the control group and 91.6% (IQR: 87.5%–93.5%) in the intervention group, with no significant difference (t = 0.439, df = 11.94, P = .67). NASA-TLX scores revealed lower mental demand in the tele-supervision group, but higher temporal demands compared to controls. Subjective evaluations indicated mixed preferences regarding on-site support; however, the majority of participants acknowledged the tele-supervision system as a viable alternative when on-site support is not feasible.

Conclusions:

This study demonstrated no statistically significant differences between the groups, indicating similar performance with high adherence to SOPs and comparable clinical decision-making in a simulated high-stakes environment. Despite increased temporal workload, user feedback was positive, underscoring the system’s potential to address staffing shortages and resource limitations. Further research in real clinical settings is needed to optimize usability and validate these findings. Clinical Trial: This study was conducted entirely in a simulated environment using a human patient simulator and did not involve real patient enrollment or collection of clinical outcomes. As such, it was classified as a simulation-based educational study and not registered in a WHO-accredited trial registry. We acknowledge the ICMJE policy and respectfully clarify that this study does not fall under its clinical trial definition.