Feasibility and Acceptance of a Tele-Trauma Surgery Consult Service to Rural and Community Hospitals: A Pilot Study.

BACKGROUND: Many trauma patients currently transferred from rural and community hospitals (RCH) to Level 1 trauma centers (L1TC) for trauma surgery evaluation may instead be appropriate for immediate discharge or admission to the local facility following evaluation by a Trauma and Acute Care Surgery (TACS) surgeon. Unnecessary utilization of resources occurs with current practice. We aimed to demonstrate the feasibility and acceptance of a Tele-Trauma Surgery Consultation (TTSC) service between L1TC and RCH.

STUDY DESIGN: L1TC TACS surgeons provided telehealth consults on trauma patients from 3 local RCHs. After consultation, appropriate patients were transferred to L1TC; selected patients remained at or were discharged from RCH. Participating TACS surgeons and RCH physicians were surveyed.

RESULTS: 28 patients met inclusion criteria during the 5-month pilot phase, 7 excluded due to workflow issues. Mean (±sd) age 63 (±17) years. Seven of 21 patients had intracranial hemorrhage; 12 had rib fractures. Mean (±sd) injury severity score (ISS) was 8.1(± 4.0). Six patients discharged from RCH, four admitted to RCH hospitalist service, two transferred to a L1TC ER, and nine transferred to L1TC as direct admission. There was one 30-day readmission and no missed injuries or complications, or deaths. RCH providers were highly satisfied with the TTSC service, TACS surgeons, and equipment used. Mental demand and effort of consulting TACS surgeon decreased significantly as consult number increased.

CONCLUSION: TTSC involving three RCH within our system is feasible and acceptable. Ten transfers and 19 ED visits were avoided. There was favorable acceptance by RCHs providers and TACS surgeons.