A Maine study outlines how two-way video and audio may address shortage of trauma care providers. and help surgeons avoid medical errors and unnecessary patient transfers
According to trauma surgeons in a telemedicine program in Maine, telemedicine can help health care providers in rural areas stabilize and treat trauma victims when long distances or inclement weather prevents immediate transfer to an accredited trauma center. The researchers presented their findings through a scientific exhibit at the 95th annual Clinical Congress of the American College of Surgeons in Chicago last week.
As Rafael Grossmann, MD, FACS, lead study author and general surgeon for Eastern Maine Medical Center in Bangor explains, an analysis of 59 telemedicine consultations has shown fewer medical errors and a virtual elimination of unnecessary transport compared with telephone consultations.
Eastern Maine Medical Center is an American College of Surgeons Level II trauma center where trauma surgeons provide consultation via telemedicine to 11 satellite centers in northern and central Maine. The network covers approximately 26,000 square miles with a population of approximately 462,000 between the Atlantic coast and Canadian border. The area is about the size of Vermont, New Hampshire and Massachusetts combined.
Telemedicine is defined as the two-way video and audio link between two or more locations. At Eastern Maine, the system is known as TeleTrauma, using high-resolution video with synchronized audio via an Internet connection. While the technology of telemedicine itself is not all that new, the study of Dr. Grossman and colleagues illustrates how surgeons are using the technology to expedite emergency care to underserved areas and the impact it can have on patient care.
In the study, the researchers collected data on 59 TeleTrauma consultations and an unspecified number of telephone-only consultations. The level of trauma and age of patients were similar in both groups, but the level of medical errors in the TeleTrauma group was about one-quarter of that in the telephone consultation group. Unnecessary transfers were seen only in the telephone consultation group.
“There is a shortage of surgeon coverage for rural areas in the United States, and this is an improved way of communicating with local providers and expanding the reach of trained trauma surgeons in Maine,” according to Dr. Grossmann.
The study authors also found that telemedicine improved surgeon preparation when receiving cases, enhanced cooperation between providers on both ends of the connection and increased satisfaction among patients and families in understanding treatment plans.
According to Dr. Grossmann, TeleTrauma also proved valuable in treating burn victims.
“It is very difficult to objectively quantify burns,” he says. “Having one of us look at the burn wounds over the high-resolution camera, we can say, ‘Yes, you can treat that locally with pain control,’ or ‘This is way over your and our heads. This patient will have to go to a ABA/ACS [American Burn Association/American College of Surgeons] certified burn center.’ The closest one is in Boston, and the helicopter can go directly from the local hospital to Boston.”
In the end, the findings from the study reveal that telemedicine has the potential to optimize trauma care delivery, says Dr. Grossmann. “Given the times in which we live, with all the technology available to us and the difficulties regarding shortages or providers and the cost of healthcare, that equation really summarizes to me that a tool like telemedicine, specifically TeleTrauma, definitely has a role in providing trauma care,” he says.
Barbara Sorondo, MD, MBA; Joanmarie Dietz Pellegrini, MD, FACS; David Jay Burke, MD, FACS; David Rydell, DO; Rony Ramia, MD; Amy Fenwick, MD; Pret Bjorn, RN; Robert E. Holmberg, MD, MPH, FACS; and Joseph Karem, MS, also participated in the telemedicine study.