Nicholas M Mohr1,2,3, Tracy Young1,4, Karisa K Harland1, Brian Skow5, Amy Wittrock5, Amanda Bell5, Marcia M Ward6. 1. 1 Department of Emergency Medicine, University of Iowa Carver College of Medicine , Iowa City, Iowa. 2. 2 Department of Anesthesia, University of Iowa Carver College of Medicine , Iowa City, Iowa. 3. 3 Department of Epidemiology, University of Iowa College of Public Health , Iowa City, Iowa. 4. 4 Injury Prevention Research Center, University of Iowa College of Public Health , Iowa City, Iowa. 5. 5 Avera eCARE , Sioux Falls, South Dakota. 6. 6 Department of Health Management and Policy, University of Iowa College of Public Health , Iowa City, Iowa.
Abstract
BACKGROUND: Emergency department (ED)-based telemedicine has been implemented in many rural hospitals to provide specialty care and expertise to patients with critical time-sensitive conditions. INTRODUCTION: The purpose of this study was to measure the impact of ED-based telemedicine on timeliness of care in participating rural hospitals. MATERIALS AND METHODS: Matched cohort study of patients seen in 1 of 14 rural hospitals in a large Midwestern telemedicine network. Telemedicine cases were matched 2:1 with controls based on age, diagnosis, and hospital. The primary outcome was door-to-provider time, and secondary outcomes included ED length-of-stay (LOS) and time-to-transfer in those transferred to other hospitals. RESULTS: Of 127,928 qualifying ED encounters, 2,857 consulted telemedicine and were matched with nontelemedicine controls. Door-to-provider time was shorter in telemedicine patients by 6.0 min (95% confidence interval [CI] 4.3-7.8 min). The first provider seeing the patient was a telemedicine provider in 41.7% of telemedicine encounters, and in these cases, telemedicine was 14.7 min earlier than local providers. ED LOS was 22.1 min shorter (95% CI 3.1-41.2) among transferred patients, but total ED LOS was longer (40.2 min, 95% CI 30.8-49.6 min) for all telemedicine patients. CONCLUSIONS: Telemedicine decreases ED door-to-provider time, most commonly because the telemedicine provider was the first provider seeing a patient. Among transferred patients, ED LOS at the first hospital was shorter in patients who had telemedicine consulted. Future work will focus on the clinical impact of more timely rural ED care.
BACKGROUND: Emergency department (ED)-based telemedicine has been implemented in many rural hospitals to provide specialty care and expertise to patients with critical time-sensitive conditions. INTRODUCTION: The purpose of this study was to measure the impact of ED-based telemedicine on timeliness of care in participating rural hospitals. MATERIALS AND METHODS: Matched cohort study of patients seen in 1 of 14 rural hospitals in a large Midwestern telemedicine network. Telemedicine cases were matched 2:1 with controls based on age, diagnosis, and hospital. The primary outcome was door-to-provider time, and secondary outcomes included ED length-of-stay (LOS) and time-to-transfer in those transferred to other hospitals. RESULTS: Of 127,928 qualifying ED encounters, 2,857 consulted telemedicine and were matched with nontelemedicine controls. Door-to-provider time was shorter in telemedicine patients by 6.0 min (95% confidence interval [CI] 4.3-7.8 min). The first provider seeing the patient was a telemedicine provider in 41.7% of telemedicine encounters, and in these cases, telemedicine was 14.7 min earlier than local providers. ED LOS was 22.1 min shorter (95% CI 3.1-41.2) among transferred patients, but total ED LOS was longer (40.2 min, 95% CI 30.8-49.6 min) for all telemedicine patients. CONCLUSIONS: Telemedicine decreases ED door-to-provider time, most commonly because the telemedicine provider was the first provider seeing a patient. Among transferred patients, ED LOS at the first hospital was shorter in patients who had telemedicine consulted. Future work will focus on the clinical impact of more timely rural ED care.
Entities:
Keywords:
emergency service; hospital; hospitals; rural; rural health services; telemedicine
Authors: Jayamalathi Priyanka Vakkalanka; Karisa K Harland; Amy Wittrock; Margaret Schmidt; Luke Mack; Matthew Nipe; Elaine Himadi; Marcia M Ward; Nicholas M Mohr Journal: J Epidemiol Community Health Date: 2019-09-06 Impact factor: 3.710
Authors: Robert McCormick; Juan Estrada; Cynthia Whitney; Mona Hinrichsen; Patrick T Lee; Adam B Cohen; Lee Schwamm; Marcelo Matiello Journal: Neurohospitalist Date: 2021-03-11
Authors: Emily M Hayden; Krislyn M Boggs; Janice A Espinola; Carlos A Camargo; Kori S Zachrison Journal: Ann Emerg Med Date: 2020-05-01 Impact factor: 5.721
Authors: Nicholas M Mohr; Chaorong Wu; Michael J Ward; Candace D McNaughton; Kelly Richardson; Peter J Kaboli Journal: BMC Health Serv Res Date: 2020-02-12 Impact factor: 2.655
Authors: Marc Felzen; Stefan Kurt Beckers; Felix Kork; Frederik Hirsch; Sebastian Bergrath; Anja Sommer; Jörg Christian Brokmann; Michael Czaplik; Rolf Rossaint Journal: J Med Internet Res Date: 2019-10-08 Impact factor: 5.428
Authors: Jochen Hinkelbein; Steffen Kerkhoff; Christoph Adler; Anton Ahlbäck; Stefan Braunecker; Daniel Burgard; Fabrizio Cirillo; Edoardo De Robertis; Eckard Glaser; Theresa K Haidl; Pete Hodkinson; Ivan Zefiro Iovino; Stefanie Jansen; Kolaparambil Varghese Lydia Johnson; Saskia Jünger; Matthieu Komorowski; Marion Leary; Christina Mackaill; Alexander Nagrebetsky; Christopher Neuhaus; Lucas Rehnberg; Giovanni Marco Romano; Thais Russomano; Jan Schmitz; Oliver Spelten; Clément Starck; Seamus Thierry; Rochelle Velho; Tobias Warnecke Journal: Scand J Trauma Resusc Emerg Med Date: 2020-11-02 Impact factor: 2.953
Authors: Nicholas M Mohr; Karisa K Harland; Uche E Okoro; Brian M Fuller; Kalyn Campbell; Morgan B Swanson; Stephen Q Simpson; Edith A Parker; Luke J Mack; Amanda Bell; Katie DeJong; Brett Faine; Anne Zepeski; Keith Mueller; Elizabeth Chrischilles; Christopher R Carpenter; Michael P Jones; Marcia M Ward Journal: J Comp Eff Res Date: 2021-01-20 Impact factor: 1.744
Authors: Matilda Hamlin; Steinn Steingrimsson; Itzhak Cohen; Victor Bero; Avishay Bar-Tl; Bruria Adini Journal: Int J Environ Res Public Health Date: 2020-07-20 Impact factor: 3.390