Feasibility and Acceptance of a Tele-Trauma Surgery Consult Service to Rural and Community Hospitals: A Pilot Study
Tovy H. Kamine, MD, FACS1,2,3 , Margaret Siu, MD3, Chelsea Spencer, MD3, Kristina Z. Kramer, MD1,3, Reginald Alouidor, MD, FACS1,3, Edward Kelly MD, FACS1,3, Ashley Deutsch, MD4, Timothy J. Mader, MD2,4, Paul Visintainer, PhD2,5, Kristina Grochowski, RN1,2, Nicolas Jabbour, MD, FACS3
1Division of Trauma, Acute Care Surgery and Surgical Critical Care, University of Massachusetts Chan Medical School - Baystate Medical Center, Springfield, MA; 2Department of Healthcare Policy and Population Science, University of Massachusetts Chan Medical School, Springfield, MA; 3Department of Surgery, University of Massachusetts Chan Medical School -Baystate Medical Center, Springfield, MA; 4Department of Emergency Medicine, University of Massachusetts Chan Medical School - Baystate Medical Center, Springfield, MA; 5Department of Medicine, University of Massachusetts Chan Medical School -Baystate Medical Center, Springfield, MA
Background: Many trauma patients currently transferred from rural/community hospitals (RCH) to Level 1 trauma centers (L1TC) for trauma surgery evaluation may be appropriate for immediate discharge or admission to the local facility following evaluation by a Trauma and Acute Care Surgery (TACS) surgeon. We aimed to demonstrate the feasibility and acceptance of a Tele-Trauma Surgery Consultation (TTSC) service between L1TC and RCHs.
Methods: L1TC TACS surgeons provided telehealth consults on trauma patients from 3 local RCHs. After consultation, appropriate patients were transferred to L1TC, selected patients remained at or were discharged from RCH. TACS surgeons and RCH physicians were surveyed.
Results: 21 patients met inclusion criteria during the 5-month pilot phase. Mean(±sd) age 63(±17) years. Seven patients had intracranial hemorrhage; 12 had rib fractures. Mean(±sd) ISS was 8.1(± 4.0). Six patients discharged from RCH, four admitted to RCH hospitalist service, two transferred to a L1TC ER, and nine transferred to L1TC as direct admission. There was one 30-day readmission and no missed injuries or complications, or deaths. RCH providers were highly satisfied with the TTSC service, TACS surgeons, and equipment. Mental demand and effort of consulting TACS surgeon decreased significantly as consult number increased.
Conclusion: TTSC involving three RCH within our system is feasible and acceptable. Ten transfers and 19 ED visits were avoided. There was favorable acceptance by RCHs providers and TACS surgeons.
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