After concluding our study, several participants from both hospitals have requested VC in emergency situations, and the system is in clinical use. We believe this strengthens our main conclusions. Qualitative research methods, as used in this study, are useful for the study of human experience,

communication and processes, especially related to interaction and activity, but cannot be applied to answer questions Inhibitors,research,lifescience,medical about numerical matters such as extent and distribution [11]. The team to team cooperation between rural and regional trauma teams should be further investigated, and new quantitative studies may address issues discovered by our qualitative approach. Conclusion VC can improve communication between hospital teams responsible for treating and triaging emergency patients, through images, vital signs, and increased interaction between team members at either side Inhibitors,research,lifescience,medical of the video link. Increased size of the consulted team may cause more interruptions to work flow around the patient when using VC, but the experts can be more involved in decision processes. Inhibitors,research,lifescience,medical VC increases likelihood of gaining a common understanding and support simultaneous work. VC facilitates the availability of the university hospital’s medical expertise and advise despite extremely long communication lines and challenging patient logistics. This cuts the time before patients are seen by specialists, and may positively affect outcome. Socio-technical design

of clinical VC systems, minimising interruptions, training of virtual teams and adaptation of working routines are important issues when LY317615 concentration implementing future systems. Competing interests The authors declare that Inhibitors,research,lifescience,medical they have no competing interests. Authors’ contributions SRB, and MG have contributed to conception and design of the study, acquisition and analysis of data and drafted the manuscript. FL has contributed to design of the study, acquisition and analysis of data and helped

drafting the manuscript. OH has contributed to conception and design of the study, and acquisition of data. All authors read and approved the final manuscript. Appendix 1: Team work, work flow and communication. Excerpts Inhibitors,research,lifescience,medical from interviews A: Responsibility and team communication LYB-doctor: VC does not change my responsibility, I still have that. LYB-nurse: If our doctor talk with an anesthesiologist down at UNN and pass that Montelukast Sodium message to me, it is often a possibility for misunderstandings. It is a lot better when I can talk directly. LYB-nurse: I ask directly, and immediately get the message I need. One saves time and frustration. LYB-doctor: With telephones I become a connecting link in passing on information. We lose a lot on that. LYB-doctor: With VC everyone got all information at once. LYB-nurse: If everyone is updated all the time, we are stronger. B: When to initiate video conferencing LYB-doctor: As a doctor here we need to see the patient first. We can not call UNN at once. (…