Authors (including presenting author) :
Yim TK (1), Lee MM (2), Lai CH (2), Lui CT (2), Tang CT (2), Chan WL(2), Chan CW (3), Kwok CW (3), Kwok A (4),Chan KC (1), Lee L (2)
Affiliation :
(1) Department of Intensive Care Unit, NTWC, (2) Department of Accident & Emergency, Tin Shui Wai Hospital, (3) Information Technology Section, NTWC, (4) Quality and Safety division, NTWC
Introduction :
ICU service is not available in all local hospitals, and an inter-hospital transport would be required for ICU consultation. Tin Shui Wai hospital (TSWH) AED and Pok Oi Hospital (POH) ICU have recently established the first teleconsultation system (eICU) for critically ill patients in Hong Kong. The purpose is to shorten transport time to ICU and minimise unnecessary inter-hospital transport.
Objectives :
1. To shorten the transport time from AED to ICU 2. To prevent unnecessary inter-hospital transport 3. To minimise the exposure of infectious cases in various clinical areas 4. Provide early multidisciplinary care
Methodology :
Before implementation of eICU, for ICU consultation, A&E doctor will phone contact Intensivist. Based on conservation information, Intensivist would decide if the patient needs ICU admission or further assessment in POH/TMH AED. After implementing eICU on 1st October 2020, a teleconsultation via Zoom will be established after the initial phone contact. The ICU doctor can assess the patient through different modalities such as direct visual and verbal assessment by a high-resolution camera, Bluetooth stethoscope, on-line documents and ECG tracings sharing and real-time ultrasound view streaming. With these, more accurate and timely evaluation is expected. The admission destination can be confirmed early.
Result & Outcome :
Data of ICU consultations were collected before and after the implementation. In September 2020, ten consultations were conducted in TSWH AED. Nine (90%) of them needed further assessment by Intensivist in POH/TMH AED. The extra time spent in AED ranged from 16 to 149 minutes (median 37 minutes, mean 60 minutes). In October 2020 (after implementation of eICU), nine consultations were conducted, and eight of them were performed with POH ICU. Among the eight POH ICU consultations, five were conducted with teleconsultations. The admission destinations of all five cases were decided in TSWH AED. No second assessment at POH AED was needed. Conclusion: eICU is effective in saving transport time to ICU and reducing unnecessary patient transport. Possible extension to other services, such as acute stroke service and neurosurgery, can be considered in remote hospitals. The eICU role model can acts as a potentially generalisable and scalable solution for all in-patient multidisciplinary specialist consultation through telehealth. Further integration with newer technologies (e.g. 4K video, VR-paired with 5G/WiFi 6) can enable a more sophisticated telehealth model for smart hospital development.
