title: Systematic review of telemedicine applications in emergency rooms.
abstract: BACKGROUND
  Despite the frequency of use of telemedicine in emergency care, limited evidence exists on its impacts at the patient, provider, organization, and system level. Hospital-based applications of telemedicine present a potentially important solution, particularly for small and rural hospitals where access to local specialists is rarely available.
  
  
  OBJECTIVE
  We conducted a systematic review of telemedicine applications for hospital-based emergency care, which aims to synthesize the existing evidence on the impact of tele-emergency applications that could inform future efforts and research in this area.
  
  
  METHODS
  A search of four databases (PubMed, CINAHL, EMBASE, Cochrane) using a combination of telemedicine and emergency room (ER) keywords for publications yielded 340 citations. Four coders independently determined eligibility based on initial criteria and then extracted information on the 38 resulting articles based on four main categories: study setting, type of technology, research methods, and results.
  
  
  RESULTS
  Of the 38 articles, 11 studies focused on telemedicine for diffuse patient populations that typically present in ERs, 8 studies considered telemedicine in the context of minor treatment clinics for patients presenting with minor injuries or illnesses, and 19 studies focused on the use of telemedicine to connect providers in ERs to medical specialists for consultations on patients with specific conditions. Overwhelmingly, tele-emergency studies reported positive findings especially in terms of technical quality and user satisfaction. There were also positive findings reported for clinical processes and outcomes, throughput, and disposition, but the rigor of studies using these measures was limited. Studies of economic outcomes are particularly sparse.
  
  
  CONCLUSIONS
  Despite limitations in their research methodology, the studies on tele-emergency indicate an application with promise to meet the needs of small and rural hospitals to address infrequent but emergency situations requiring specialist care. Similarly, studies indicate that tele-emergency has considerable potential to expand use of minor treatment clinics to address access issues in remote areas and overcrowding of urban ERs.
authors.affiliation: Department of Health Management and Policy, University of Iowa, 100 CPHB-N250, 145 Riverside Dr., Iowa City, IA 52242, USA. Electronic address: marcia-m-ward@uiowa.edu.
authors.forename: Marcia M
authors.initials: MM
authors.lastname: Ward
authors.affiliation: Health Management, Telfer School of Management, University of Ottawa, 55 Laurier Avenue East, Ottawa, ON, Canada K1N 6N5. Electronic address: jaana@telfer.uottawa.ca.
authors.forename: Mirou
authors.initials: M
authors.lastname: Jaana
authors.affiliation: Department of Health Management and Policy, University of Iowa, 100 CPHB-N250, 145 Riverside Dr., Iowa City, IA 52242, USA.
authors.forename: Nabil
authors.initials: N
authors.lastname: Natafgi
mesh_terms: D004632:Emergency Medical Services / Q000379:methods*; D006801:Humans; D017216:Telemedicine / Q000706:statistics & numerical data*
keywords: Emergency department; Emergency room; Systematic review; Tele-emergency; Telehealth; Telemedicine