RESUMEN
Background: Telemedicine in neurosurgery or teleneurosurgery has been widely used for transmission of clinical data and images throughout the country since its implementation in 2006. The impact is a reduction of patient number that need to be reviewed in the level III hospitals and an increment in the number of patients that are kept in level II hospitals for observation by the primary team. This translates to reduction of unnecessary transfer of patients and subsequently cost benefits for patients and medical providers. The main aim is to determine the amount of reduction in unnecessary transfer by the implementation of teleneurosurgery in the management of referrals to neurosurgical department in Hospital Sultanah Amninah Johor Bahru (HSAJB). Other factors associated with transfer decision are also evaluated. Methods: This prospective cohort study was conducted in HSAJB, Johor over four months. A total of 349 subjects referred to HSAJB are included with 12 subjects excluded. The subjects are followed up from the time of referral until three months post-referrals. Related data includes the decision before and after reviewing the radiological images on teleconsultation website with clinical data available. Results: There was a significant reduction in the number of inter-hospital transfer. 37% of transfer is avoided and patients are best kept in their original hospitals. However, there are additional findings in which there are 20.1% of patients that thought does not require transfer based on clinical data alone, would have to be transferred when the clinical data and images are reviewed. This translates to an increment of 20.1% need to be observed in neurosurgical center. Without the images, these patients might be observed in the referral hospitals with higher risk of deterioration. Other factors that are related to transfer decision apart from images include Glasgow Coma Scale (GCS) and diagnosis. The GCS significantly associated with transfer when only clinical data is reviewed. However, in situation where clinical data and images are reviewed together, the GCS and diagnosis are significantly associated with transfer decision. On multi-factorial analysis, more of mild head injury being transferred for observation in neurosurgical unit after images and clinical data reviewed which correlates to an increment from 1.85% to 3.9%. Another finding is reduced of risk of patients transferred for trauma from 1.85% to 0.519% after the data reviewed. Conclusion: Teleneurosurgery is beneficial in the management of referrals from level II hospitals. The inter-hospital transfer is significantly reduced, however there is an increased in the number of patients that need to be observed in neurosurgery unit for the risk of potential deterioration.
RESUMEN
El trabajo colaborativo y aprendizaje en red, constituye una estrategia vinculadora, de articulación e intercambio entre instituciones y/o personas, que deciden asociar voluntaria y concertadamente sus esfuerzos, experiencias y conocimientos para el logro de fines comunes, este intercambio tendrá un mayor alcance si son apoyados por las tecnologías de la información y las comunicaciones (TIC) como alternativas de comunicación. La red de enfermería Informática de Cuba se ha propuesto varios objetivos de trabajo que permitan el empoderamiento de estas herramientas para la gerencia, asistencia, docencia e investigación, con el objetivo de facilitar la articulación entre los miembros de la red y sus grupos a través de una plataforma fácil y amigable, que permita el intercambio y fortalecimiento de la actividad de enfermería, la educación permanente y la investigación en este campo de acción. Se realiza una revisión bibliográfica y documental de las actividades realizadas a través de las grabaciones efectuadas en la sala virtual y el registro de participantes en la base de dato. De diciembre del 2011 a noviembre del 2013 se ha trasmitido a través de teleconferencias un Taller, 3 entrenamientos en Elluminate, 8 Reuniones virtuales y 11 teleconferencias. Se ha logrado progresivamente que el personal de enfermería identifique la potencialidad y el alcance que tiene esta herramienta, para el intercambio científico y las actividades académicas, cumpliéndose así los objetivos propuestos en el presente trabajo(AU)
The collaborative work and the networked learning are a linking strategy of articulation and exchange among institutions and or/persons that decide to combine in a voluntary and concerted way their efforts, experiences and knowledge to attain common objectives. This exchange will have greater scope if they are supported by the information and communication technologies (ICT) as communication alternatives. The informatic nursing network of Cuba has several work objectives that allow the empowerment of these tools for management, assistance, teaching and research. The aim is to facilitate the articulation among the members of the network and their groups through an easy friendly platform encouraging exchanges and strengthening of the nursing activity, permanent education and research in this field. A literature and documentary review of the activities was made through recordings taken in the virtual room and the register of participants included in the database. From December 2011 to November 2013, one workshop, 3 Elluminate-based training courses, 8 virtual meetings and 11 teleconferences have been transmitted. It has been managed that the nursing staff gradually identifies the potentialities and the scope of this tool for scientific exchange and for academic activities, thus complying with the set objectives of the present paper(AU)