The use of a computer-based image link system to assist inter-hospital referrals

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Abstract
Early CT scanning leads to the early diagnosis and referral of intracranial lesions, particularly in head injuries. Such early scanning is more feasible with the advent of CT scanners in most peripheral hospitals. However, the neurosurgical service in most countries remains regional with limited bed capacity and involves a potentially hazardous inter-hospital transfer of critically ill patients. We investigated the value and reliability of new information technology in the management of emergency neurosurgical referrals in the Mersey region. One hundred and niney-nine emergency referrals were studied. In 147 referrals the patient was scanned in the referring hospital and the images were transmitted immediately to the neurosurgical unit. Of these, 51 (34.7%) patients were transferred immediately, 14 (9.5%) the following day and 11 (7.5%) electively. Of those patients who were transferred immediately, 48 (94.1%) underwent emergency surgery. Seventy-one (48.3%) patients were not transferred due to diffuse head injury (40), a cerebral infarct (15), poor grade subarachnoid haemorrhage (10) and normal scans (6). Another 52 patients were transferred to the unit without image transfer, of whom 12 (23.1%) underwent emergency surgery, 17 (32.7%) went back to the referring hospital within 24 h, 17 (32.7%) were electively operated and six (11.5%) died. Comparison of 100 original CT scan films with the corresponding transmitted images showed no significant difference in the quality of the image, diagnosis or clinical decision. Image transfer together with the clinical history has reduced potentially hazardous inter-hospital transfer of patients (p<0.001). It is reliable, fast, cheap and leads to considerable economic savings.