With 5 800 residents, the Cilaos commune is one of the most isolated areas on Réunion Island. Since November 2007, the commune's only hospital has been providing emergency care via telemedicine in cooperation with Unit 15 of the South Reunion Hospital Group (GHSR) in Saint-Pierre, which is 45 km away, but requires a travel time of 90 minutes along an abrupt route.
In the past, the establishment was faced with a "lack of medical coverage in the evenings and on Sundays," sometimes resulting in "the dispatch of a SMUR unit in the absence of a medical contact" at the risk of "mobilising inadequate resources," said the report.
The construction of a telemedicine room allows for the simultaneous exchange of data - mainly photos in the cases of trauma or electrocardiograms - with the doctors of Unit 15.
The guidance of patients admitted to the Cilaos emergency room and the eventual instructions for care and transport are decided remotely by a GHSR dispatching doctor, assisted on site by medical staff. A computerised medical record, shared by Unit 15, keeps track of telemedicine activities that have been performed.
In 2010, 168 patients received this medical treatment (196 patients in 2009) for an average of 80 minutes (72 minutes in 2009). Most patients (62 %) went through Unit 15, while nearly a quarter (23 %) came voluntarily.
Most teleconsultations (82 %) took place on off-duty hours during the week between 5:00 pm and 8:00 am and on Saturdays, Sundays and public holidays. The reasons for teleconsultation are most often medical (82 %), although the first specialty identified (trauma, 15 %) is far behind 'miscellaneous' (34 %).
Following an examination, 47 % of patients were taken to the GHSR emergency room by non-emergency response vehicles, while a SMUR unit only intervened in one case. Furthermore, 28 % of patients were returned to their homes.
The report mentions, however, two technical deficiencies which should be resolved in 2011 by "installing a camera that is linked to an urgent medical aid service" and "the computerisation of patient records linked to the GHSR hospital information network." 2011 should also signify the "creation of a functional 'telemedicine' unit" at Cilaos hospital.
These changes do not however solve the problem of sustainable financing for telemedicine at Cilaos. In 2010, the Ministry of Health granted an endowment (Migac) of less than €13 000 for telemedicine, the total cost of which exceeded €108 000. The cost of paramedic procedures performed under telemedicine was slightly higher than €1 000, but were not invoiced.
Further information:
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Quelle/Source: epractice, 28.03.2011
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