Evaluating Telemedical Supervision for Critical Anesthesia Scenarios: Randomized Controlled Simulation Study

Telemedicine may improve access to specialized care, but its use for supervision during critical anesthesia situations remains underexplored. A standardized tele-supervision (TSV) solution for operating rooms (ORs) is lacking.

This study aimed to evaluate a novel telemedical supervision system for critical anesthetic scenarios in a simulated OR environment and compare it to traditional on-site supervision. Specifically, adherence to standard operating procedures (SOPs), the number and modality of senior physician contacts, workload, and user perceptions were assessed.

In this randomized controlled simulation study, 16 anesthesiology residents in their first 2 years of training at the Uniklinik Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen (Germany) were randomized using block randomization into 2 groups. The intervention group received remote support exclusively via a TSV system, while the control group used a conventional phone with on-site support. The telemedical system comprised an anesthesia workstation that integrated data from the patient monitor, anesthesia device, and syringe pumps using the Institute of Electrical and Electronics Engineers (IEEE) 11073 Service-Oriented Device Connectivity (SDC) standard and a mobile supervision workstation that enabled the senior physician to monitor multiple ORs and communicate via text, audio, and video. The simulated scenario involved a male patient aged 51 years undergoing an appendectomy who developed an anaphylactic reaction 3 minutes after receiving cefuroxime. Primary outcomes focused on the completion rate of necessary SOP measures. Secondary outcomes included workload, measured using the NASA Task Load Index (NASA-TLX), and participants' postscenario questionnaire responses. Statistical comparisons were performed using a Welch t test.

All participants in both groups contacted the senior physician at least once. The control group had a mean of 6.44 (SD 4.80) SOP measures supported by the senior physician, whereas the intervention group had a mean of 5.00 (SD 3.06). The mean SOP completion rate was 92.5% (SD 0.04%) in the control group and 91.6% (SD 0.05%) in the intervention group, with no significant difference (t_11.94=0.439; P=.67). NASA-TLX scores revealed that compared to the control group, there was lower mental demand in the TSV group but higher temporal demand. Subjective evaluations indicated mixed preferences regarding on-site support; however, most participants acknowledged the TSV system as a viable alternative when on-site support was not feasible.

This study demonstrated no statistically significant differences between the groups, indicating similar performance with high adherence to SOPs and comparable clinical decision-making in a simulated high-stakes environment. Despite increased temporal workload, user feedback was positive, underscoring the system's potential to address staffing shortages and resource limitations. Further research in real clinical settings is needed to optimize usability and validate these findings.