Usability of Telepresence in a Level 1 Trauma Center
Carl Ivan Schulman, MD, PhD, MSPH, FACS,Antonio Marttos, MD, Jill Graygo, MA, MPH, MDEd,Paul Rothenberg, BA, Gabriel Alonso, Shannon Gibson, PhD,Jeffrey Augenstein, MD, PhD, and Elizabeth Kelly, MAWilliam Lehman Injury Research Center, Division of Trauma and Surgical Care, University of Miami Miller School of Medicine,Miami, Florida.
Limited resources and the diminishing physician work- force in trauma require unique and innovative solutions. Our hy- pothesis is that telepresence by a remote physician is an appropriate application in an urban trauma setting. The purpose of this study isto assess user satisfaction and usability of a mobile telemedicine robot in trauma care.
Materials and Methods:
A usability study of trauma patient assessments utilizing the Remote Presence-7 (RP-7)robot (InTouch Health, Santa Barbara, CA) with real-time, two-way communication between remote and local physicians was conducted at a Level 1 trauma center. Usability and acceptability was measured using survey questionnaires, open-ended feedback, and general ob-servations. Comparisons were made between remote and local phy-sician responses.
One hundred fourteen patient encountersutilizing telepresence were performed. Remote and local physiciansexpressed a high level of satisfaction with the mobility (92% and 79%, respectively), communication (97% and 90%, respectively),and visual abilities (91% and 97%, respectively) of the RP-7 robot for remote consultation purposes. On average, 89% of remote and local physician participants rated their overall telemedicine experi-ence as ‘‘excellent’’ or ‘‘above average.’’
This study suggests that telepresence of a remote trauma surgeon may be auseful and functional adjunct in the trauma setting. Further devel-opment of these technologies could mitigate current and future concerns about gaps in rural and urban trauma care and critical care staffing shortages and during mass casualty or disaster scenarios.
robotic surgery, telemedicine, telesurgery, technology
his study evaluates physician acceptance of the RemotePresence-7 (RP-7) mobile unit (InTouch Health, SantaBarbara, CA) for use in a Level 1 trauma center. The RP-7mobile unit presents a unique technological innovationconsisting of a fully capable bidirectional communication systemhoused in the robot itself and a control station through which phy-sicians can remotely monitor, interact with, and communicate withpatients and on-site medical staff. The RP-7 provides real-time, se-cure, bidirectional video and audio feed. This technology has nu-merous potential uses in the delivery of medical care in general andcan provide access to care, consultation, and training that are des-perately needed in the today’s trauma care environments. The RP-7links on-site clinicians with remote physicians who can provideparticular expertise that would not otherwise be available on-site inthe timely manner required in trauma care.It has long been acknowledged that there are multiple challengesconfronting the trauma profession and trauma care delivery in theUnited States.
Current dissatisfaction with trauma as a surgicalresidency rotation and a career choice is on the rise. Residents aregenerally dissatisfied because of nonoperative care duties and thestructure of trauma rotations, whereas career trauma surgeons suffer from burnout and stress as a result of in-house call, night shifts,heavy workloads, and insufficient income. As a result of these andother factors such as the increase in the general and elderly popu-lations, it is predicted that by 2020, there will be a 6% deficit of surgeons in the United States.
Furthermore, it has been argued thatby the year 2020, the critical care sector will be unable to provideeven the current level of care let alone increase the amount of in-tensivists staffed.
The main priority of trauma clinicians is to achieve timely assess-mentanddiagnosisofallincomingpatients.Anydelayinbothpatientassessment and physician response can result in lost opportunities toimprove patient outcome and can result in increased morbidity andlength of stay.
The increased concern over future intensivist staffinghasledtoproposalsforalternativessuchasuniquestaffingparadigms,the regionalization of critical care, and the increased use of techno-logical innovations such as telemedicine applications.Early telemedicine studies have documented successes and im-provement in patient care, particularly in relation to improved andearly triage of severely injured patients, decreased rate of unneces-sarypatienttransfer,andimproved communicationfromgroundandair ambulance providers. The application of telemedicine has beenexplored in a growing number of medical specialties, from derma-tology to psychiatry, over the last three decades.
Only in the lastfew years has telemedicine been applied to trauma, critical care, andemergency surgical specialties.
The integration of telemedicine into the trauma environment ex-tends the reach of the trauma care specialists beyond the limits im-posedbytimeanddistance.Thisstudyhypothesizesthattelepresenceis a useful and acceptable technology for an experienced traumaphysician to successfully participate in the assessment and care of atrauma patient from a remote location.
248 TELEMEDICINE and e-HEALTH
APRIL 2013 DOI: 10.1089/tmj.2012.0102