The Impact of a The Impact of a Telehealth Web-based Telehealth Web-based

Solution for Neurosurgery Solution for Neurosurgery Triage and ConsultationTriage and Consultation

Monica Moya, Jessica M. Valdez, Monica Moya, Jessica M. Valdez, Dr. Howard Yonas & Dr. Dale C. AlversonDr. Howard Yonas & Dr. Dale C. Alverson

University of New Mexico Health Sciences University of New Mexico Health Sciences Center, Albuquerque, New MexicoCenter, Albuquerque, New Mexico

IntroductionIntroduction

HYPOTHESESHYPOTHESESA Telemedicine Web-based solution through A Telemedicine Web-based solution through which brain CT images could be viewed by a which brain CT images could be viewed by a consulting neurosurgeon for use in triage consulting neurosurgeon for use in triage decisions regarding the transfer of decisions regarding the transfer of neurosurgical patients from rural areas to a neurosurgical patients from rural areas to a tertiary care neurosurgical center will result in:tertiary care neurosurgical center will result in:

1. 25% avoidance of transfers and 1. 25% avoidance of transfers and

2. 25% management recommendation 2. 25% management recommendation changes independent of the transfer decisionchanges independent of the transfer decision

IntroductionIntroduction

Possible BenefitsPossible Benefits Allows the neurosurgeon to make a more informed decision Allows the neurosurgeon to make a more informed decision

regarding the transfer of the patient, as well as the acute regarding the transfer of the patient, as well as the acute patient management patient management

Allows for more rational use of limited resources at the Allows for more rational use of limited resources at the tertiary care center and reduces costs by reducing the tertiary care center and reduces costs by reducing the number of transfersnumber of transfers

Increases revenue for the rural community hospitals due to Increases revenue for the rural community hospitals due to

the decreased transfer rates and keeping patients locally for the decreased transfer rates and keeping patients locally for care and monitoring care and monitoring

Reduces the anxiety for those who would not benefit from a Reduces the anxiety for those who would not benefit from a transfer and may receive treatment at their home institution transfer and may receive treatment at their home institution

MethodsMethods

Medical images produced at a referring Medical images produced at a referring hospital were sent to the consulting hospital hospital were sent to the consulting hospital via a secure/HIPAA compliant web-based via a secure/HIPAA compliant web-based program called IMEDCONprogram called IMEDCON

Evaluated cases which required Neurosurgery Evaluated cases which required Neurosurgery consult from November 2007 to October 2008 consult from November 2007 to October 2008

Medical images received by the consulting Medical images received by the consulting physicians were then coupled with 3 yes-no physicians were then coupled with 3 yes-no questions in order to gather the data questions in order to gather the data necessary to test the hypothesesnecessary to test the hypotheses

Methods continued…Methods continued… The three questions:The three questions:

1.1. Before reviewing the case with the supporting Before reviewing the case with the supporting information, based on your current knowledge information, based on your current knowledge would you have accepted this patient for would you have accepted this patient for transport? transport?

2.2. After reviewing the case with the supporting After reviewing the case with the supporting information, did you accept this patient for information, did you accept this patient for transport?transport?

3.3. Did your management recommendations change? Did your management recommendations change?

Answers to these questions were then compiled in a Answers to these questions were then compiled in a database by a system support specialistdatabase by a system support specialist affiliated affiliated with IMEDCON. with IMEDCON.

ResultsResults

At UNMH there were 39 consultations from 8 At UNMH there were 39 consultations from 8 referring hospitals during the study periodreferring hospitals during the study period 25/39 (64%) of consultations were considered to 25/39 (64%) of consultations were considered to

be requests for transportsbe requests for transports After review of CT only 14/25 (56%) cases After review of CT only 14/25 (56%) cases

actually resulted in transport and thus 44% of actually resulted in transport and thus 44% of transports were avoidedtransports were avoided

17/39 (44%) of the neurosurgeon consultations 17/39 (44%) of the neurosurgeon consultations resulted in recommended management changes resulted in recommended management changes independent of transportindependent of transport

56% of those not transported56% of those not transported 21% of those transported21% of those transported

Results continued…Results continued…

Hypothesis 1 Hypothesis 1 Results exceeded an expected avoidance Results exceeded an expected avoidance

transfer rate of 25%transfer rate of 25%

In 44% cases, neurosurgeons with telephone In 44% cases, neurosurgeons with telephone consult only would have accepted the patient consult only would have accepted the patient for transport but upon the availability of the for transport but upon the availability of the patient images they changed their decision in patient images they changed their decision in 44 % of cases and the patient remained at 44 % of cases and the patient remained at their local healthcare facility.their local healthcare facility.

Results continued…Results continued…

Hypothesis 2 Hypothesis 2 Results exceeded expected Results exceeded expected

management recommendation changes management recommendation changes of 25%of 25%

Using the Web-based telemedicine Using the Web-based telemedicine system, neurosurgeons made system, neurosurgeons made management recommendation changes management recommendation changes in 44% cases independent of transfer in 44% cases independent of transfer

SummarySummary Our data suggests a web-based telemedicine Our data suggests a web-based telemedicine

triage system:triage system: Helps physicians make more informed and timely Helps physicians make more informed and timely

transfer decisionstransfer decisions Helps to decrease unnecessary transfers and Helps to decrease unnecessary transfers and

avoidance of costsavoidance of costs Avoids the unnecessary use of limited resources and Avoids the unnecessary use of limited resources and

beds at the Level 1 trauma centerbeds at the Level 1 trauma center Allows patients to remain in their communities Allows patients to remain in their communities

closer to family supportcloser to family support Is a relatively simple and cost effective approach for Is a relatively simple and cost effective approach for

head trauma triagehead trauma triage

Questions or Comments?Questions or Comments?

For additional Information and For additional Information and References contact:References contact:

Monica Moya: Monica Moya: momoya@salud.unm.edumomoya@salud.unm.edu