Journal article
Telemedicine Use Decreases Rural Emergency Department Length of Stay for Transferred North Dakota Trauma Patients
Telemedicine journal and e-health, Vol.24(3), pp.194-202
03/01/2018
DOI: 10.1089/tmj.2017.0083
PMID: 28731843
Abstract
Background:
Telemedicine has been proposed as one strategy to improve local trauma care and decrease disparities between rural and urban trauma outcomes.
Objectives:
This study was conducted to describe the effect of telemedicine on management and clinical outcomes for trauma patients in North Dakota.
Methods:
Cohort study of adult (age ≥18 years) trauma patients treated in North Dakota Critical Access Hospital (CAH) Emergency Departments (EDs) from 2008 to 2014. Records were linked to a telemedicine network's call records, indicating whether telemedicine was available and/or used at the institution at the time of the care. Multivariable generalized estimating equations were developed to identify associations between telemedicine consultation and availability and outcomes such as transfer, timeliness of care, trauma imaging, and mortality.
Results:
Of the 7,500 North Dakota trauma patients seen in CAH, telemedicine was consulted for 11% of patients in telemedicine-capable EDs and 4% of total trauma patients. Telemedicine utilization was independently associated with decreased initial ED length of stay (LOS) (30 min, 95% confidence interval [CI] 14–45 min) for transferred patients. Telemedicine availability was associated with an increase in the probability of interhospital transfer (adjusted odds ratio [aOR] 1.2, 95% CI 1.1–1.4). Telemedicine availability was associated with increased total ED LOS (15 min, 95% CI 10–21 min), and
computed tomography scans
(aOR 1.6, 95% CI 1.3–1.9).
Conclusions:
ED-based telemedicine consultation is requested for the most severely injured rural trauma patients. Telemedicine consultation was associated with more rapid interhospital transfer, and telemedicine availability is associated with increased radiography use and transfer. Future work should evaluate how telemedicine could target patients likely to benefit from telemedicine consultation.
Details
- Title: Subtitle
- Telemedicine Use Decreases Rural Emergency Department Length of Stay for Transferred North Dakota Trauma Patients
- Creators
- Nicholas M Mohr - 3Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IowaJ. Priyanka Vakkalanka - 3Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IowaKarisa K Harland - 1Department of Emergency Medicine, University of Iowa College of Medicine, Iowa City, IowaAmanda Bell - 4Avera eCARE, Sioux Falls, South DakotaBrian Skow - 4Avera eCARE, Sioux Falls, South DakotaDan M Shane - 5Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, IowaMarcia M Ward - 5Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, Iowa
- Resource Type
- Journal article
- Publication Details
- Telemedicine journal and e-health, Vol.24(3), pp.194-202
- DOI
- 10.1089/tmj.2017.0083
- PMID
- 28731843
- NLM abbreviation
- Telemed J E Health
- ISSN
- 1530-5627
- eISSN
- 1556-3669
- Publisher
- Mary Ann Liebert, Inc
- Language
- English
- Date published
- 03/01/2018
- Academic Unit
- Rural Telehealth Research Center; Health Management and Policy; Epidemiology; Economics; Emergency Medicine; Anesthesia; Injury Prevention Research Center; Public Policy Center (Archive); Law Faculty
- Record Identifier
- 9984024530002771
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