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Tele-Trauma Consult Service: Updates on Benefits and Barriers at 2 Years
Margaret Siu, MD
1, Kristina Kramer, MD, FACS
2, Eleanor Winston, MD, FACS
2, Kristina Grochowski, MSN, RN
2, Yamuna Carey
2, Reginald Alouidor, MD, FACS
2, Nicolas Jabbour, MD, FACS
1, Edward Kelly, MD, FACS
2, Tovy H. Kamine, MD, FACS
2,
3
1Department of Surgery, University of Massachusetts Chan Medical School -Baystate Medical Center, Boston, MA, 2Division of Trauma, Acute Care Surgery and Surgical Critical Care, University of Massachusetts Chan Medical School - Baystate Medical Center, 3Department of Healthcare Policy and Population Science, University of Massachusetts Chan Medical School
Background: Unnecessary trauma transfers burden the trauma systems approximately $27 million/year. We established a Tele-trauma Consult Service (TTSC) between three rural/community hospitals and a level 1 trauma center (L1TC) to prevent overtransfer of trauma patients to L1TC. Our objective is to assess cost savings of TTSC in the first two years of establishment and identify barriers to the program.
Methods: Cost allocation on trauma patients enrolled in TTSC between 11/28/2021 to 11/28/2023 were compared to cost allocation of patients who were directly transferred to L1TC during same time frame, designated as control group. We compared patient outcomes between groups and age of trauma surgeons performing TTSC against those who elected to transfer patients directly. Chi square and t-test analysis were used, with significance set at p<0.05.
Results: TTSC had 117 patients and control group had 195 patients. For TTSC, 25% of patients were transferred to L1TC; 35% directly discharged home. There was no difference in ED or hospital length of stay between groups. Mean cost allocation for TTSC patients was $5,264.50 (95%CI[$3,997.18-$6,531.83]) vs. $10,214.78 (95%CI[$8,537.96-$11,891.61]) for control, p<0.0001. Average age of surgeon accepting TTSC was 42 years vs. 51 years for control, p<0.0001.
Conclusion: TTSC significantly reduces hospital cost among trauma patients without compromising length of stay. If all eligible TTSC patients participated, approximately 1.5 million dollars would be saved in two years. However, utilization of TTSC remains limited among older trauma surgeons. To prevent over-transfer of trauma patients and optimize resource utilization, additional exposure and minimizing workflow demands of tele-medicine platform are warranted.
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