Teletrauma: Putting it all Together Rich Bias, Sr. VP MCG Health Debra Kitchens, RN, Trauma Program Manager MCCG Cyndie Roberson, RN, Director of Patient Intake, CHOA

Background and Significance

Disparities exist in trauma morbidity and mortality based on a rural or urban care setting The relative risk of a rural victim dying in a motor vehicle crash is 15 times higher than in urban areas

87% of rural pediatric traumas do not survive to reach the hospital

Injury related deaths are 40% higher in rural communities

Solution:

•   Program began July 2009 •   Goal – to enable rural emergency department practitioners

and trauma patients access to a team of surgeons and specialists at a Level I Trauma Center

•   Innovative and cutting edge technology used to save lives, increase efficiency, and improve the level of care

Teletrauma Network

Level I

Trauma Center

Rural ED Rural ED

Rural ED

Rural Partners

Dodge County Hospital Fairview Park Hospital Peach Regional Medical

Center Taylor Regional Hospital

Phase I Region V: Trauma Center Medical Center of Central

Georgia

Advantages to Teletrauma Network •   Enable rural trauma team to

virtually add a trauma specialist to their response team

•   Utilizes real-time visual link which greatly enhances the trauma specialists ability to participate in care

•   Improved communication, improve continuum of care

•   Improve relationships between health care providers

•  Aid in the initial evaluation, treatment, and care of the patients which can improve outcomes and reduce cost

•   Positive attitude toward use of the telemedicine system •   73% indicated that using telemedicine is a good idea •   80% reported that using telemedicine is a positive step •   87% reported they plan to use telemedicine for trauma in

the future •   53% noted that using telemedicine increases their

effectiveness •   58% found system useful in their jobs

•   Clinical Outcomes •   67% reported using system

makes it easier to evaluate patients

•   Overall satisfaction was reported to be 69%

Results from Phase I

MCG Health, Inc

•   Emanuel Medical Center

•   Washington County Regional Medical Center

•   Burke Medical Center •   Jefferson Hospital •   McDuffie Regional

Medical Center

Memorial Health University Medical Center

•   Jeff Davis Hospital •   Bacon County Hospital •   Effingham County Hospital •   Satilla Regional Medical

Center •   Coffee Regional Medical

Center

Children's Healthcare of Atlanta

•   Habersham County Medical Center

•   Chatuge Regional Hospital •   Miller County Hospital

Moving Forward Phase II: 2 additional Level I Trauma Centers, 1 Pediatric Specialty

Center and 18 Rural Hospitals

•   Transfer patterns to Trauma Centers

Identification of Rural Partners

•   By Proxy Credentialing

Credentialing

•  Basic Inservice •  Advanced end to end process testing

Training/Inservice

•  Trauma Physician availability 24/7

Process Go Live

Phase II Process and Implementation

Evaluation and Outcome

Patient remains at local hospital for care

Patient transferred to Level I Trauma Center for further evaluation and treatment

Collaborative Evaluation through telemedicine enhanced primary and secondary survey

Synergistic determination for treatment plan and patient disposition

Patient Arrival in Rural Emergency Room

Notification to Level I trauma Center

Through enhanced resources physician collaboration increases the likelihood of a positive outcome

•  ATLS stabilization and transport guidelines and principles can be directed by the trauma surgeon

•  Mutual decisions for patient disposition ensure the most efficient use of resources without compromising outcome

.

Telemedicine Process and Flow Enhanced access to specialty consultation

•  Use of a standardized process will allows comparison of outcomes for all sites •  Additional component added to determine perceptions influencing intentions of trauma and emergency team members to support the use of a telemedicine system for trauma

•  Specific Questions: •  What are the perceptions of trauma and emergency team members about the use of a telemdicine system for trauma •  What are the relationships between pre and post implementation perceptions and intentions to support the use of a telemedicine system for trauma •  What effect did the use of a telemedicine system have on the number of transfers to the Level I trauma center

Phase II Evaluation

Based on the outcomes from Phase I and Phase II of the project next steps will be determined. The goal is to be able to provide telemedicine services for trauma care throughout the state of Georgia

Questions ?