Telecounselling
General hospital specialists or exceptionally a General Practitioner requests the opinion of the tertiary hospital specialists on a clinical case. The service can be provided according to various modalities:
Asynchronously (secure e-mail type interaction). The requesting professional sends the query to the tertiary hospital specialists and waits for a reply. The maximum delay in replying to a query must have been agreed beforehand between the requester and the tertiary hospital. Both the request and the counsellor answer make use of standard forms, agreed among all the actors involved in the tele-counselling. Such forms must contain all the clinical and anamnesis information needed to provide a feedback through tele-counselling. Moreover such forms must be validated through digital signature according to EU and national regulations. Results from diagnostic procedures (e.g. X-Ray, lab results, E.C.G., etc) as well as excerpts from the patient?s clinical records can be attached to the form. As an alternative, temporary remote access to the patient?s clinical records can be provided to the specialist through an adequate authentication procedure;
Interactively (through videoconferencing facilities). In this case the healthcare professionals can talk and see each other and thus share information about the patient. They are even able to work on the same item while being at different hospitals (?whiteboard? feature), seeing e.g. where the other has put the cursor. This modality normally requires booking an appointment with the tertiary hospital specialist as in the case of a normal referral unless standby or emergency arrangements are in place between the requesting party and the tertiary hospital.
Tele-counselling service for Neurosurgery - market validation phase
Introduction
One of the major problem in the organisation of healthcare services in a specific territory is related to the organisation of highly specialised services such as neurosurgery. In fact, skills in these medical fields are particularly scarce and diagnostic and surgical equipment expensive. Until now, Health Authorities had to face the dilemma of spreading neurosurgery structures over their territory, generating high costs, or centralising skills and equipment, leaving part of their territory uncovered. Thanks to advances in ICT, it is now possible to reorganise the neurosurgery set-up at regional level by networking high specialised centralised services with peripheral structures (i.e. general hospitals and emergency rooms). To succeed in this reorganisation, it is essential to rethink the whole handling of neurosurgery patients and to divide those with severe traumas, which require immediate attention, from those who suffer of minor traumas and who can be treated with less urgency. By analysing the workflow relative to the handling of this kind of patients, three main actors are easily identified: the peripheral hospital, the tertiary hospital and the specialist who is in standby and can be contacted remotely.
Objectives
The objectives of the service are:
reducing mortality and morbidity resulting from cranio-encephalic trauma and spine injury by reducing transfer times and by improving the appropriateness of patient transfers to a neurosurgery centre;
avoiding transfers due purely to the need of a neurosurgical consultation[1], and also preventing ?undertriage?[2]? for patients requiring surgical intervention or sophisticated monitoring;
improving the ability to rapidly diagnose serious injury for patients non transferred to a neurosurgery centre;
rationalising the use of human and technological resources;
establishing uniform levels of trauma care throughout the Region, through the use of standardised protocols;
guaranteeing equality of treatment to all citizens victim of a trauma, irrespective of where it occurs within the regional boundaries
releasing financial resources.
It should be remembered that the integration between the cranial trauma care guidelines and the telemedicine protocols is an essential element in the proper management of transfers between general hospitals and neurosurgery centres.
Upon positive assessment of the initial use of the tele-counselling service for skull-encephalic traumas and spine injuries, which will be given priority because of their life threatening character, and because of the expertise available in the centres initially selected for participating to the validation, the extension of the tele-counselling service to other trauma pathologies ? e.g. serious pelvic traumas, cardiac or large vessel injuries, or internal organ injuries ? will be considered.
