Telemedicine System May Enable Faster Care, Reduce Costs

Data from the Arkansas Hand Trauma Telemedicine System’s first year of operation, presented in Scientific Poster P240, suggest that patients requiring only general orthopaedic care did not travel as far to receive that care as those requiring a hand specialist. By minimizing distance, patients received faster care by using healthcare resources in relatively close proximity, resulting in lower costs to the patient and the system.

Furthermore, time to disposition for transfer was more efficient for patients requiring a hand specialist, which the study authors contend may reflect the severity of the injury as well as reduced options for acceptance. The investigators also found that hand injuries requiring consultation and transfer are taken care of equally as efficiently whether during normal business or after hours for both hand specialists and general orthopaedics.

The authors assert that, overall, these data illustrate the clinical and likely financial impact of a telemedicine system for hand trauma, especially for a largely rural state with limited resources, such as Arkansas.

“Arkansas is a largely rural state,” noted Wesley S. Greer, MD, one of the study’s authors, explaining the impetus for the study. “Telemedicine promised a method to expand the footprint of our limited hand specialists and provide better and timelier care for the citizens of Arkansas.”

Conducting the study
The Arkansas Hand Trauma Telemedicine System works in conjunction with the Arkansas Trauma Communication Center (ATCC) to coordinate care of traumatic hand injuries in Arkansas. The system uses preexisting telemedicine equipment located in emergency departments throughout Arkansas. The on-call hand surgeon uses tablet computers to connect to the remote site and provide video evaluation and treatment recommendations.The investigators hypothesized that using the telemedicine system would result in an alteration of disposition patterns favoring local and general orthopaedic care. Additionally, they believed that transfer for general orthopaedic care would result in faster disposition and shorter distances for travel and that the system would demonstrate efficiency in after-hours disposition.

Data on the following areas were collected from the ATCC database from the first year of implementation (Jan. 1, 2014–Dec. 31, 2014):

  • type of telemedicine
  • need for and type of transfer
  • time to acceptance for transfer
  • distance to receiving facility

After hours was defined as between the hours of 5:00 p.m. and 7:00 a.m., Monday through Thursday; and between the hours of 5:00 p.m. Friday and 7:00 a.m. Monday. The investigators used the data to conduct statistical analysis using the Student T-Test.

Evaluating results
In 2014, there were 331 patients with hand trauma, of which 298 received telemedicine consultations (90 percent). Of these patients, 195 (65 percent) received live video consultations and the remaining 103 (35 percent) received telephone-only consultations. After telemedicine consultation, 164 patients (55 percent) were deemed appropriate for local care while 134 (45 percent) required transfer to another facility. Of the 134 transfers, there were 91 video consultations (68 percent) and 43 telephone consultations (32 percent). Seventy-two patients were transferred for care by a hand specialist (52 video consultations and 20 telephone consultations), and 62 patients were transferred for general orthopaedic care (39 video consultations and 23 telephone consultations).

Patients being transferred for general orthopaedic care traveled an average of 60.21 miles, while patients transferred to an instate hand specialist traveled an average of 92.184 miles. This was found to be a significant difference between the transferred patients (P < 0.05, with P = 0.0001). The time from initiating contact with the ATCC and acceptance of the patient for transfer averaged 50.46 minutes for all patients. For patients requiring general orthopaedic care, the average was 48.58 minutes, while patients transferred to an instate hand specialist took an average of 38.90 minutes for acceptance.

The researchers noted there was a significant difference in time to acceptance between general orthopaedists and hand specialists (P < 0.05, with P = 0.02). After-hours transfers for a hand specialist within the state averaged 37.11 minutes and averaged 41.09 minutes during business hours; this was found not to be statistically significant (P = 0.25). Transfers for general orthopaedic care after hours averaged 46.71 minutes and 51.12 minutes during business hours. Time of day for general orthopaedic acceptance was not found to be significant (P = 0.267).

Drawing conclusions
“Using a telemedicine program enabled our patients to be effectively and efficiently treated at the appropriate level of care,” noted Dr. Greer. “We found that within our trauma system, arranging for acceptance of a patient to a hand specialist took less time than to a general orthopaedic surgeon. Another significant finding was that our patients were able to be accepted for care with no significant difference found during both normal business hours and after hours.”

According to Dr. Greer, the program is a “win” for all involved.

“There is less of a financial burden for the trauma system due to a decrease in unnecessary transfers to a hand specialist,” he asserted. “Local doctors and orthopaedic surgeons can accept and treat injuries for which they are comfortable with providing care. Patients can receive local and timely care, as appropriate, which likely increases patient satisfaction and treatment convenience.”

Dr. Greer added that “this program involves seven hand surgeons from the state, two of whom are in academic practice and five of whom are in private practice. This shows great statewide collaboration among physicians from different types of practices and locations within the state.”                        

Dr. Greer’s coauthors for Scientific Poster P240, “The Arkansas Hand Trauma Telemedicine System: A Review of the First Year” are John W. Bracey, MD; Mark A. Tait, MD; Sophie B. Hollenberg, BS; and senior authors John M. Stephenson, MD; and Theresa O. Wyrick, MD.

Details of the authors’ disclosures as submitted to the Orthopaedic Disclosure Program can be found in the Final Program; the most current disclosure information may be accessed electronically at www.aaos.org/disclosure

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