Emergency Department Telemedicine Is Used for More Severely Injured Rural Trauma Patients, but Does Not Decrease Transfer: A Cohort Study

Mohr, Nicholas M.; Harland, Karisa K.; Chrischilles, Elizabeth A.; Bell, Amanda; Shane, Dan M.; Ward, Marcia M.

doi:10.1111/acem.13120

Cited by 37 publications

(41 citation statements)

References 20 publications

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“…The overall purpose of conducting this analysis was to identify areas where novel delivery of specialty care might avoid the need for some VHA transfers. In civilian health systems, ED-based telemedicine has been used to provide specialty provider and nursing support with the goal of improving transfer appropriateness [23][24][25][26][27][28][29][30][31]. This service has been most broadly implemented in telestroke care, providing real-time video consultation by a neurologist to an ED for the purpose of selecting patients for intravenous thrombolysis [32].…”

Section: Discussionmentioning

confidence: 99%

Potentially avoidable Inter-Facility transfer from Veterans Health Administration emergency departments: A cohort study

Mohr

Ward

et al. 2020

BMC Health Serv Res

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Background: Inter-facility transfer is an important strategy for improving access to specialized health services, but transfers are complicated by over-triage, under-triage, travel burdens, and costs. The purpose of this study is to describe ED-based inter-facility transfer practices within the Veterans Health Administration (VHA) and to estimate the proportion of potentially avoidable transfers. Methods: This observational cohort study included all patients treated in VHA EDs between 2012 and 2014 who were transferred to another VHA hospital. Potentially avoidable transfers were defined as patients who were either discharged from the receiving ED or admitted to the receiving hospital for ≤1 day without having an invasive procedure performed. We conducted facility-and diagnosis-level analyses to identify subgroups of patients for whom potentially avoidable transfers had increased prevalence. Results: Of 6,173,189 ED visits during the 3-year study period, 18,852 (0.3%) were transferred from one VHA ED to another VHA facility. Rural residents were transferred three times as often as urban residents (0.6% vs. 0.2%, p < 0.001), and 22.8% of all VHA-to-VHA transfers were potentially avoidable transfers. The 3 disease categories most commonly associated with inter-facility transfer were mental health (34%), cardiac (12%), and digestive diagnoses (9%). Conclusions: VHA inter-facility transfer is commonly performed for mental health and cardiac evaluation, particularly for patients in rural settings. The proportion that are potentially avoidable is small. Future work should focus on improving capabilities to provide specialty evaluation locally for these conditions, possibly using telehealth solutions.

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Section: Discussionmentioning

confidence: 99%

Potentially avoidable Inter-Facility transfer from Veterans Health Administration emergency departments: A cohort study

Mohr

Ward

et al. 2020

BMC Health Serv Res

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“…The USA has seen a dramatic expansion in telehealth programme driven by the critical need to provide high-quality care while reducing healthcare costs 1–24. To date, most acute care telehealth activity has focused on Telestroke1 2; however, Emergency Medicine (EM) is a specialty uniquely positioned to directly impact patient movement and system utilisation.…”

Section: Introductionmentioning

confidence: 99%

Telehealth dashboard: leverage reporting functionality to increase awareness of high-acuity emergency department patients across an enterprise practice

Heaton

Russi

Monroe³

et al. 2019

BMJ Health Care Inform

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BackgroundEmergency Medicine Telehealth (TeleEM) represents an opportunity to work directly with referral centres, rural facilities and underserved areas to mitigate unnecessary testing, optimise resource utilisation and facilitate patient transfers across health systems. To optimise the impact of a TeleEM programme, a tool is needed to remotely monitor patient activity in multiple emergency department facilities, concurrently.MethodsAfter identifying data sources for activation criteria put forth by the TeleEM operations group, rules were constructed within the electronic health record to facilitate data checks and ultimately produce a yes/no response if the category’s conditions were met. Responses were organised into a table, with functionality allowing end users to drill into the different sites to see patient-specific information for patients meeting activation criteria.ConclusionsThe TeleEM dashboard allows for proactive engagement by the TeleEM physician and strengthens the team-based approach of critically ill.

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“…Several studies have discussed the role of telemedicine in avoiding unnecessary transfers across different settings [33, 43-46, 48, 100]. Others found that telemedicine is not independently associated with probability of transfer [61,98]. While some studies showed evidence of increased transfer rates in competitive tertiary care environments associated with telemedicine implementation [101].…”

Section: Discussionmentioning

confidence: 99%

“…Research Center at the University of Iowa. These centers were involved in several studies that explored the quality of care in CAHs [20][21][22][55][56][57] and designed comparative effectiveness studies to test multiple hypotheses related to quality and timeliness of care in rural hospitals using telemedicine [33,[58][59][60][61].…”

Section: Gaps In Existing Knowledgementioning

confidence: 99%

Improving care delivery in critical access hospitals

Natafgi¹

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Emergency Department Telemedicine Is Used for More Severely Injured Rural Trauma Patients, but Does Not Decrease Transfer: A Cohort Study

Cited by 37 publications

References 20 publications

Potentially avoidable Inter-Facility transfer from Veterans Health Administration emergency departments: A cohort study

Potentially avoidable Inter-Facility transfer from Veterans Health Administration emergency departments: A cohort study

Telehealth dashboard: leverage reporting functionality to increase awareness of high-acuity emergency department patients across an enterprise practice

Improving care delivery in critical access hospitals

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