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Evaluation of a French Regional Telemedicine Network Dedicated to Neurological Emergencies: A 14-Year Study.

BACKGROUND
Equality in healthcare between urban and rural areas is problematic in France. Telemedicine networks are expected to improve equality in expertise assessment. We aimed to evaluate the use and impact of a regional rural French telemedicine network, dedicated to medical and surgical neurological emergencies, on interhospital patient transfers.


METHODS
Eight community hospital emergency departments were remotely connected to the only university hospital in Franche-Comté, France. We prospectively obtained data from all patients consecutively admitted to emergency care departments in the region and who received medical or neurosurgical expertise by telemedicine from January 2002 to December 2015. The reasons for requesting expertise, number of requested neurological opinions, and interhospital patient transfers were analyzed. Economic savings were determined by estimating the cost of avoided transfers.


RESULTS
A total of 23,710 patients had telemedicine consultations in the region. The network was used by every community hospital (independently of the existence of local neurological teams). These consultations were overwhelmingly for cases of stroke (30%) and head or spinal injuries (36%). Cerebral tumors represented 9% of teleconsultations. In 2015, 75% of patients admitted to the remote hospitals that did not have onsite neurological expertise nevertheless received neurovascular tele-expertise. The rate of thrombolyzed patients dramatically increased within 13 years regionally (9.9%) and 33.5% of thrombolyses were performed by telemedicine. The number of patients examined by telemedicine and admitted for head or spinal injuries also increased over the 13-year period (12% vs. 21%). Secondary interhospital transfers were halved for both pathologies. The estimated saving is ∼€3.5 million.


CONCLUSION
Telemedicine networks facilitate acute-phase neurological assessment and prevent unnecessary secondary interhospital transfers.