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Telemedicine Improves Rural ER Response Time

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."

John Commins is a senior editor at HealthLeaders.


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