Improving Rural Trauma Care, Education and Prevention through Telemedicine

EXECUTIVE SUMMARY 

Trauma care in four rural hospitals in New York and Vermont has been supplemented by tele-trauma consults provided by Fletcher Allen Health Care.

Surveys completed by the participating physicians after each use of the telemedicine system indicates that the FAHC consultant trauma surgeons and the remotely located referring providers:

• thought that the consult improved the quality of care for over half of the cases,
• usually thought that the consult could not have been performed as well by telephone,
• thought that ease of use of the equipment was usually at least adequate,
• rated video quality overall as slightly better than audio quality, and
• felt that communication was at least adequate for all consultations.

Qualitative interviews and observations at two sites indicate that:

• when the telemedicine works as designed, it does not interfere with standard ER procedures and the consultant can interact with the ER personnel clearly and effectively;
• the program operates as the first stage of FAHC's management of a patient to be transferred. At the time of the interviews no patients were kept from transferring as a result of the tele-consults.

Analysis of the FAHC trauma registry shows that:

• three of the four hospitals had a shorter time between injury at the accident scene and arrival at FAHC for teletrauma patients, with an overall mean difference of  34.8 minutes.  However, this difference was not statistically significant.  The small sample size limits the power to detect differences between the groups. However, it does raise the question for future study whether the use of the teletrauma system resulted in more expeditious transfer to the trauma center.
• the length of stay of teletrauma patients was not significantly longer than length of stay for direct admission trauma patients,
• there is no difference in mortality between teletrauma and direct admission patients, and
• teletrauma patients had slightly more complications than direct admission patients during their stay at FAHC, but the difference was not statistically significant.

Evaluation of the trauma education workshops found:

• Almost all participants rated the workshops as excellent, good, or satisfactory
• Telemedicine enabled 65% of participants to attend workshops that they otherwise would not have attended
• Telemedicine enabled 35% of participants to save travel to attend the workshops

To view the final report in its entirety, please click here.

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