Date of Graduation

Fall 8-9-2014

Degree Type

Capstone Project

Degree Name

Master of Science in Physician Assistant Studies

Abstract

Background: There are disproportionally high rates of traumatic injuries in rural populations with high rates of mortality. Rural trauma patients are more likely to be transferred to a Level 1 trauma center for definitive care than are trauma patients in urban settings. Telemedicine offers the ability to bring the trauma center to the rural patient allowing advanced assessment, resuscitation, and disposition at the local community hospital. Through the means of telemedicine, the number of trauma transfers can be reduced which will in turn reduce costs to the healthcare system while improving patient care.

Methods: A comprehensive search was performed using multiple databases including: Medline-OVID, Medline-PubMed, Web of Science, and Google Scholar. The following MESH terms and keywords were used in combination for this search: emergency service, trauma, rural, rural hospital, telemedicine, telepresence, transport, cost, and cost analysis. Each study found in the initial search was screened for eligibility criteria as well as citations for more relevant articles.

Results: Of the 20 studies found in the search, 3 met the eligibility criteria for this review. Each study demonstrated the ability of telemedicine to allow local community hospitals to assess and treat trauma patients and negate the need for transfer to a trauma center. Duchesne et al saw an 89% decrease in the number of trauma transfers, and Latifi et al and Rogers et al avoided transfers in roughly 23% of patients. Latifi et al estimated cost savings from transports alone was as high as $203 952 over 4 years, while Duchesne et al showed total hospital costs could be reduced by approximately $6.5 million over 5 years. As technology has advanced, so has the cost, and the budget for implementing a telemedicine program was reported to be as low as $10 000 per facility by Rogers et al.

Conclusion: Extrapolation of current studies shows that telemedicine may be an effective alternative to emergency transfers of trauma patients from remote community hospitals to trauma centers. This allows for early definitive care at the local hospital with the guidance of a specialist at the trauma center. As the cost of transferring patients increases and the cost of technology decreases it may become financially beneficial for healthcare systems to implement telemedicine programs.

Keywords: Telemedicine, telepresence, rural populations, rural hospitals, trauma, trauma transfers, emergency transports, cost.

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