Effectiveness of Recruiting Specialist Physicians for Critical Elderly Patients in Remote Islands

SummaryBackgroundA previous study demonstrated the effectiveness of video-telemedicine in reducing the frequency of unnecessary air medical transports and costs for screening of patients requesting emergency air medial transport (EAMT). The purpose of this study is to investigate the effectiveness of recruiting specialist physicians for critical patients, especially elderly patients, in remote islands.MethodsThis study compares one prospective and two historical cohorts. Stage 1 (S1) was the stage without preflight screening and stage 2 (S2) was followed with preflight video-telemedicine screening. Stage 3 (S3) was the stage involving recruiting specialists from the main island. Effectiveness estimates were calculated comparing monthly EAMT applications, actual flights and approval rate among the three stages.ResultsThere were 948 EAMT applications, including 685 S1 patients, 137 S2 patients (45 elderly patients) and 126 S3 patients (56 elderly patients). Patient demographics among the three groups were similar. We showed a decreasing trend in monthly EAMT applications from 19.60 (S1), 13.70 (S2) to 7.88 (S3) (p < 0.05). The average number of flights/month also significantly decreased from 19.60 (S1), 12.50 (S2), to 6.75 (S3) (p < 0.05). The approval rate of EAMT requests among 3 stages fell from 100% (S1), to 91.2% (S2), and 85.7% (S3).ConclusionRecruiting specialist physicians from the main island to remote islands not only reduces EAMT requests significantly, but also improves care for critical elderly patients in remote islands.