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Telemedicine OK for ICU Coma Assessment, Researchers Say

Analysis  |  By Alexandra Wilson Pecci  
   March 14, 2017

Assessments of coma severity were similar when conducted remotely and in person, Mayo Clinic researchers found.

Telemedicine is a reliable way to assess comatose patients, according to new research. Stroke assessments via telemedicine have been studied before, but research conducted at the Mayo Clinic Hospital in Arizona and published in Telemedicine and e-Health is the first to look specifically at using telemedicine for patients in a coma.

The study was conducted over a 15-month period and included 100 patients who were randomly assigned two Mayo Clinic physicians, one who conducted their assessments at the bedside and another who assessed patients via a desktop workstation on another floor in the same hospital.

Chasing the ROI of Telemedicine

The study's senior author, Bart Demaerschalk, MD, a professor of neurology and medical director of telemedicine at the Center for Connected Care at Mayo Clinic College of Medicine, told HealthLeaders Media that a physician on a different floor could remotely drive and control the robotic telemedicine unit that was at the foot of the bed.

The physicians each used two scoring systems, the Glasgow Coma Scale and the Full Outline of UnResponsiveness Score (FOUR) scale, to independently and simultaneously assess the patients. They did not share with each other their determinations.

According to Demaerschalk, the study "demonstrated very nicely" that whether the physicians were assessing the patients remotely or in person, their assessments of the severity of the coma were very similar.

Demaerschalk and Amelia Adcock, MD, a Mayo Clinic neurologist and first author of the study, say that their findings are good news for providers using telemedicine to deliver specialist care to underserved areas.

"There is a shortage of intensive care unit providers and facilities with round-the-clock patient coverage," Adcock said in a media statement. "Telemedicine can provide a way to ameliorate this shortage and improve early evaluation of critically ill patients."

Although telemedicine is a good complement to in-person care, it's not meant to be a substitute.

"My goal and that of my fellow researchers is not to replace the human examination, it's not to replace the human element in healthcare," Demaerschalk said. Instead, it can function as a supplement to the local resources and personnel expertise.

If no neurologist is available to assess a stroke patient, the alternative might be transferring that patient, which is not only costly but can take precious time.

The time it takes to transfer a patient could potentially take her out of the window for a treatment opportunity. Using telemedicine can help clinicians start a needed treatment before transfer and may prevent some transfers altogether.

Demaerschalk says that connected care works best for clinical disciplines where there is less of a need to touch the patient, such as tele-psychology and tele-neurology.

Assistive Devices Helpful
This was reflected in the Mayo study, which noted that the most challenging assessment was looking at a patient's pupillary reaction in response to light. The bedside nurses had difficulty keeping the eyelid elevated enough for the neurologist viewing it on screen.

But Demaerschalk also says that technology is constantly advancing, and even specialties that require some form of physical exam can plug assistive devices, such as a stethoscope, into the robot at the bedside.

Researchers pointed to a potential solution to the pupillary reaction problem: Devices called pupilometers, which objectively measure the diameter of a pupil in ambient light and that can be a peripheral attachment to the robotic telemedicine unit.

Demaerschalk believes that telemedicine has a role in every discipline, "If one is imaginative and looks to the future." It's up to researchers to tailor the way telemedicine is used based on where they find it works best and where it's less effective.

"Nothing is off the table," he says. "It's our job to ask these questions."

Collaboration is Key
Mayo Clinic is asking those questions in the context of its Center for Connected Care, where Demaerschalk is medical director.

The objective of the Center "is to ensure that when patients present to a community hospital with an emergency that they have available to them the same or similar expertise as if they were presenting to one of the main Mayo Clinic campuses," he says.

For hospital administrators, Demaerschalk notes that successful development of telemedicine programs still "rests quite soundly on the relationships that are developed and maintained between the two hospitals or health systems that are working collaboratively."

Alexandra Wilson Pecci is an editor for HealthLeaders.

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