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Significant Institutional Cost Savings from A Tele-Trauma Surgery Consultation Service
Margaret Siu, MD1, Kristina Kramer, MD, FACS2, Eleanor Winston, MD, FACS2, Kristina Grochowski, MSN, RN2, Yamuna Carey MD2, Reginald Alouidor, MD, FACS2, Nicolas Jabbour, MD, FACS1, Edward Kelly, MD, FACS2, Tovy H. Kamine, MD, FACS2,3 1 Department of Surgery, University of Massachusetts Chan Medical School -Baystate Medical Center 2 Division 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: Many trauma transfers to level 1 trauma centers (L1TC) are unnecessary. A Tele-Trauma Surgery Consultation (TTSC) service was established involving a trauma surgeon consultation to emergency physicians at non-trauma centers. We analyzed the cost benefit in utilizing tele-trauma consultations in the first year of the program.

Methods: Trauma surgeons from L1TC performed telehealth consults on trauma patients presenting at three rural and community hospitals (RCH) with local physicians bedside. Following TTSC evaluation, selected patients either remained at RCH or were transferred to L1TC. Total cost allocation of hospitalization including RCH visit and transfer were obtained for TTSC patients and a control group of all patients who were eligible for TTSC but did not receive TTSC due to workflow issues.

Results: TTSC group had 55 patients and control group had 91 patients. Mean age was 64 years (95%CI [58.7-69.5]) for TTSC and 65 (95%CI [61.7-70.1]) for control. Mean ISS was 6.5 (95%CI [5.3-7.6]) vs. 8.1 (95%CI [7.3-9.0]), p=0.02. Mean cost allocation per patient was $5,563.47 for TTSC, compared to $8,700.93 for control, p= 0.02. One-year total cost savings were $172,560.30 with TTSC. There was no difference among emergency department LOS (8.3 hours vs 11.0 hours, p=0.24) or hospital LOS (3.0 days vs 3.8 days, p=0.17) between the two groups.

Conclusion: TTSC is associated with significant cost savings. Had all eligible patients received a TTSC consultation, one year savings would be ~$460,000. A dedicated surgeon for TTSC would likely be cost effective.
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