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Telemedicine Improves Rural ER Response Time

News  |  By John Commins  
   January 11, 2018

Among patients who were transferred to other hospitals, the length-of-stay at the emergency room in the first hospital was shorter for patients who had telemedicine consults.

Emergency department patients at rural hospitals using telemedicine see a clinician six minutes sooner than patients in hospitals that have no such technology, a new study from University of Iowa shows.

And if that first clinician assessment is through a telemedicine encounter, as was the case 42% of the interactions examined in the study, the door-to-provider time is shortened by nearly 15 minutes, says study lead author Nicholas Mohr, MD, an emergency physician and associate professor at the Carver College of Medicine at the University of Iowa.

"If we are talking about 15 minutes for a patient in a rural hospital, that can be important for patients who have certain very serious diseases," says Mohr, who is also a researcher with the university’s Rural Telehealth Research Center.

"Especially in remote hospitals, that 15 minutes saved could change outcomes for patients with particular conditions that we would expect would be most sensitive to that, such as severe trauma, stroke, myocardial infarction," he says.

Related: Telehealth Is More Disruptive Than We May Think

Mohr's study looked at data from 14 hospitals in Iowa, Kansas, Nebraska, North Dakota, and South Dakota that subscribe to telemedicine services from Avera eCARE Services, an emergency medicine telemedicine provider based in Sioux Falls, SD. The research matched 2,857 emergency department cases that used telemedicine services with non-telemedicine controls.

Among patients who were transferred to other hospitals, the length-of-stay at the emergency room in the first hospital was shorter for patients who had telemedicine consults. 

"For patients who will need rapid transfer to a tertiary care facility, having a provider to start to effect that transfer probably makes as much difference as anything," Mohr says. "We’ve shown in earlier studies that among transferred patients when telemedicine is involved those patients who have major trauma, for instance, are transferred more quickly."

"That is probably a combination of being able to see patients more quickly and also because they can start the transfer. They can send a helicopter, for example, or they can get a receiving clinician to help with the transfer. All of those things to do that require someone seeing the patient can be started," he says.

Mohr says the link to subspecialist expert consultation provided through telemedicine comes as more rural hospitals staff their emergency departments with advanced practice providers, such as nurse practitioners and physician assistants.

"As we see that that is the case, one question that is raised is how do you provide supervision and backup to all of those providers?" Mohr says. "Telemedicine can be one really powerful way of providing that supervision."

The study showed that most patient encounters in the rural emergency department can be completed by local staff without an outside consultation, Mohr says.

"The consultation rate was about 3.5%, meaning that if 30 people walked into a rural emergency department, 29 were going to be treated without ever consulting the TM provider," Mohr says. "But, that 30th person is the one that the local clinician pushes the button and asks for help."

"Having that option available to them can be valuable," he says. "We've heard in some of our prior work that local clinicians value that, in terms of recruitment and retention. They appreciate having a telemedicine provider there, either to help with transfer or documentation, or to help with supervision of advanced practice providers."

Mohr says telemedicine finally appears to be catching on with rural providers. In North Dakota, for example, he says 80% of critical access hospitals use telemedicine services.

"In some regions where there are maybe extrinsic factors that make it challenging to staff emergency departments, there is a lot of value in having that tertiary care center expertise in those emergency departments," Mohr says. "It's becoming a minority of hospitals that don’t have telemedicine available."

"Barriers to telemedicine adoption for years were legislative and licensure barriers and broad band access, especially in rural areas," he says. "As broadband speeds are getting faster and rural communities are being connected to more broadband providers, that is making telemedicine available where previously it wasn’t, even when they wanted it."

Mohr says that telemedicine is not the silver bullet that will remove obstacles to healthcare access in rural America, but he sees it as part of the solution.

"And it will continue to be a bigger part of the solution as there are more telemedicine providers, and we figure out how telemedicine can best influence the care that patients receive, as broad band internet connectivity improves, and the quality of the connection at rural hospitals improves," he says. "All of those things will coalesce for telemedicine to continue to expand the scope of emergency care."

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.

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