Teleradiology for remote consultation using iPad improves the use of health system human resources for paediatric fractures: Prospective controlled study in a tertiary care hospital in Italy

Floriana Zennaro, Daniele Grosso, Riccardo Fascetta, Marta Marini, Luca Odoni, Valentina Di Carlo, Daniela Dibello, Francesca Vittoria, Marzia Lazzerini

Research output: Contribution to journalArticle

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Abstract

Background: The growing cost of health care and lack of specialised staff have set e-Health high on the European political agenda. In a prospective study we evaluated the effect of providing images for remote consultation through an iPad on the number of in-hospital orthopaedic consultations for children with bone fractures. Methods. Children from 0 to 18 years diagnosed with a bone fracture by the radiologist during the hours when an orthopaedic service is provided only on-call were eligible for enrollment. Cases were enrolled prospectively during September and October 2013. A standard approach (verbal information only, no X-Ray provided remotely) was compared to an experimental approach (standard approach plus the provision of X-ray for remote consultation through an iPad). The primary outcome was the number of orthopaedic in-hospital consultations that occurred. Other outcomes included: immediate activation of other services; time needed for decision-making; technical difficulties; quality of images and diagnostic confidence (on a likert scale of 1 to 10). Results: Forty-two children were enrolled in the study. Number of in-hospital consultancies dropped from 32/42 (76.1%) when no X-ray was provided to 16/42 (38%) when the X-rays was provided (p <0.001). With remote X-ray consultation in 14/42 (33.3%) cases services such as surgery and plaster room could be immediately activated, compared to no service activated without teleradiology (p <0.001). Average time for decision making was 23.4 ± 21.8 minutes with remote X-ray consultation, compared to 56.2 ± 16.1 when the X-ray was not provided (p <0.001). The comparison between images on the iPad and on the standard system for X- Ray visualisation resulted in a non statistically significant difference in the quality of images (average score 9.89 ± 0.37 vs 9.91 ± 0.30; p =0.79), and in non statistically significant difference in diagnostic confidence (average score 9.91 ± 0.32 vs 9.92 ± 0.31; p = 0.88). Conclusions: Remote X-ray consultation through Aycan OsiriX PRO and iPad should be considered as a means for reducing the need of in-hospital orthopaedic consultation during on-call times, and potentially decrease the cost of care for the health system. In the future, alternative systems less expensive than Aycan OsiriX PRO should be further developed and tested.

Original languageEnglish
Article number327
JournalBMC Health Services Research
Volume14
Issue number1
DOIs
Publication statusPublished - Jul 28 2014

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Teleradiology
Remote Consultation
Tertiary Healthcare
Tertiary Care Centers
Italy
X-Rays
Prospective Studies
Pediatrics
Health
Referral and Consultation
Orthopedics
Bone Fractures
Health Care Costs
Decision Making

Keywords

  • Children
  • Cost
  • Fractures
  • Organisation of care
  • Teleradiology

ASJC Scopus subject areas

  • Health Policy
  • Medicine(all)

Cite this

Teleradiology for remote consultation using iPad improves the use of health system human resources for paediatric fractures : Prospective controlled study in a tertiary care hospital in Italy. / Zennaro, Floriana; Grosso, Daniele; Fascetta, Riccardo; Marini, Marta; Odoni, Luca; Di Carlo, Valentina; Dibello, Daniela; Vittoria, Francesca; Lazzerini, Marzia.

In: BMC Health Services Research, Vol. 14, No. 1, 327, 28.07.2014.

Research output: Contribution to journalArticle

Zennaro, Floriana ; Grosso, Daniele ; Fascetta, Riccardo ; Marini, Marta ; Odoni, Luca ; Di Carlo, Valentina ; Dibello, Daniela ; Vittoria, Francesca ; Lazzerini, Marzia. / Teleradiology for remote consultation using iPad improves the use of health system human resources for paediatric fractures : Prospective controlled study in a tertiary care hospital in Italy. In: BMC Health Services Research. 2014 ; Vol. 14, No. 1.
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AU - Fascetta, Riccardo

AU - Marini, Marta

AU - Odoni, Luca

AU - Di Carlo, Valentina

AU - Dibello, Daniela

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N2 - Background: The growing cost of health care and lack of specialised staff have set e-Health high on the European political agenda. In a prospective study we evaluated the effect of providing images for remote consultation through an iPad on the number of in-hospital orthopaedic consultations for children with bone fractures. Methods. Children from 0 to 18 years diagnosed with a bone fracture by the radiologist during the hours when an orthopaedic service is provided only on-call were eligible for enrollment. Cases were enrolled prospectively during September and October 2013. A standard approach (verbal information only, no X-Ray provided remotely) was compared to an experimental approach (standard approach plus the provision of X-ray for remote consultation through an iPad). The primary outcome was the number of orthopaedic in-hospital consultations that occurred. Other outcomes included: immediate activation of other services; time needed for decision-making; technical difficulties; quality of images and diagnostic confidence (on a likert scale of 1 to 10). Results: Forty-two children were enrolled in the study. Number of in-hospital consultancies dropped from 32/42 (76.1%) when no X-ray was provided to 16/42 (38%) when the X-rays was provided (p <0.001). With remote X-ray consultation in 14/42 (33.3%) cases services such as surgery and plaster room could be immediately activated, compared to no service activated without teleradiology (p <0.001). Average time for decision making was 23.4 ± 21.8 minutes with remote X-ray consultation, compared to 56.2 ± 16.1 when the X-ray was not provided (p <0.001). The comparison between images on the iPad and on the standard system for X- Ray visualisation resulted in a non statistically significant difference in the quality of images (average score 9.89 ± 0.37 vs 9.91 ± 0.30; p =0.79), and in non statistically significant difference in diagnostic confidence (average score 9.91 ± 0.32 vs 9.92 ± 0.31; p = 0.88). Conclusions: Remote X-ray consultation through Aycan OsiriX PRO and iPad should be considered as a means for reducing the need of in-hospital orthopaedic consultation during on-call times, and potentially decrease the cost of care for the health system. In the future, alternative systems less expensive than Aycan OsiriX PRO should be further developed and tested.

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