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Pediatric trauma telemedicine in a rural state: Lessons learned from a 1-year experience
Mark A Taylor1, Miguel L Knochel2, Spencer J Proctor3
1University of Utah, Department of Surgery, Salt Lake City, UT.
Insights
Pediatric trauma telehealth programs can safely prevent unnecessary patient transfers. This initiative prevented 16 transfers in its first year by enabling local observation of injured children.
Area of Science:
- Emergency Medicine
- Pediatric Trauma Care
- Telehealth Implementation
Background:
- 27% of pediatric trauma transfers are potentially preventable.
- Developing a state-wide pediatric trauma telehealth network to reduce transfers.
- Instituted a telehealth program with a partner hospital.
Purpose of the Study:
- To report the experience of a new pediatric trauma telehealth program over its first year.
- To evaluate the safety and efficacy of telehealth in managing pediatric trauma patients.
- To assess the impact of telehealth on preventing unnecessary transfers to a Level 1 Pediatric Trauma Center.
Main Methods:
- Retrospective review of pediatric trauma patients from January 2019 to February 2020.
- Categorization of patient disposition: telehealth consultation, admission under head trauma protocol, or transfer without consultation.
- Data collection included demographics, hospital course, and patient outcomes via chart review.
Main Results:
- Eight telehealth consultations were performed, primarily for head injuries.
- Fifteen patients were admitted under a head trauma protocol without telehealth, all discharged after observation.
- The program prevented 16 transfers, with 3 additional patients potentially avoiding transfer.
- No patients required transfer to the Pediatric Trauma Center after telehealth or protocol-based observation.
Conclusions:
- Pediatric trauma telehealth is a safe method for preventing transfers of patients suitable for local observation.
- A collaborative head trauma protocol led to increased local admissions for observation.
- The program demonstrated significant success in reducing transfers from a partner facility.
Background:
Previous research from our center has shown that 27% of the pediatric trauma transfers from referring facilities are potentially preventable. Our hospital is the only level 1 pediatric trauma center (PTC) in our state, and we are developing a pediatric trauma telehealth network to help keep certain injured children closer to home. We instituted a pediatric trauma telehealth program with a partnering community-based hospital in our state and aim to report our experience over the first year.
Methods:
All pediatric trauma patients that presented to our partnering hospital from January 2019 to February 2020 were reviewed. Disposition was: a) telehealth consultation, b) admission to the children's unit without a telehealth consultation per our head trauma protocol, or c) transfer without telehealth consultation. Data on demographics, hospital course, and disposition were collected via chart review.
Results:
Eight patients underwent telehealth consults and another 8 patients were admitted to the partnering hospital's children's unit based on the head trauma protocol without a telehealth consult. Patient's ages ranged from 7 months to 15 years. Of the patients that underwent telehealth consult, 7 presented with a head injury and 1 presented with a rib fracture/small pneumothorax. The patient with a pneumothorax was observed for 6 h and discharged home after a repeat chest x-ray was stable. All 15 patients with head injuries were observed and discharged from either the emergency department or children's unit after passing concussion testing. No patients required transfer to our PTC after observation, and none were readmitted. Fifty-six patients were transferred without telehealth consultation, and 3 of these patients could potentially have avoided transfer with a telehealth consultation.
Conclusions:
Telehealth in pediatric trauma can be a safe mechanism for preventing the transfer of patients that can be safely observed at a partnering hospital. From a facility that transfers an average of 30 trauma patients per year to our hospital, this program prevented 16 such transfers. Development of a head trauma protocol in collaboration with a pediatric neurosurgeon leads to an unexpected number of patients being admitted to the partnering hospital for observation without utilization of a telehealth consultation.
Type Of Study:
Retrospective study.
Level Of Evidence:
III.
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