Avera's eEmergency service allows emergency-trained physicians to assist local providers in cases of trauma, heart attack, stroke and other critical situations through use of two-way video technology and integrated electronic medical-records.
Rural hospitals face several challenges in maintaining access to high-quality care for their communities. They struggle to recruit staff, access specialists and keep pace with technology and trends.
Among the challenges is the reality that rural hospitals serve a greater percent of elderly patients. In the Avera service area, 18% of the population is over 65, compared to the national average of 13%. Elderly persons are more likely have chronic diseases, take multiple prescribed medications and suffer traumatic falls, heart attacks and strokes. While the needs of elderly patients increase, it is important to note that the overall population of rural communities continues to decrease.
On top of high healthcare needs, rural residents lack access to specialty care. Though primary care in rural communities is just like primary care in large metropolitan communities, large metropolitan communities have more options for medical specialty support when the need arises. For example, rural facilities often lack the expertise to effectively diagnose and treat strokes. This creates a “rural penalty” in stroke care. Clot-busting tPA treatment carries a risk of intracranial hemorrhage or bleeding, and several “stroke mimics” can lead to misdiagnoses. One study found that nearly a fifth of patients diagnosed with ischemic stroke had their diagnoses changed after the CT scan was read.
Lack of specialty access can impact outcomes for other rural emergencies. South Dakota is in the top 6% nationally for fatal traffic and occupational injuries. (The region's leading industry, agriculture, increases the risk of traumatic injury). Whether stroke, trauma or heart attack, in all of these cases, fast access to emergency physicians and medical specialists impacts outcomes.
Workforce shortages are another problem. Rural communities struggle with recruitment, resulting in a lack of physicians, nurses, pharmacists and other healthcare providers. Adding to the difficulty of recruitment, compared to their urban counterparts, rural physicians spend many more hours covering the emergency department after hours and on weekends, causing retention issues, physician fatigue and burnout. Rural physicians often feel isolated and alone, without peers to consult or provide backup on the sickest patients unlike the process of care were trained in during residency programs.
Through eEmergency's two-way audio-visual technology, local emergency department teams can:
- Consult with specialists at the touch of a button
- Access support during difficult and multiple emergency cases
- Keep patients close to home
- Initiate diagnostic testing sooner
- Streamline emergency transport when needed
- Provide longer-term support when transfer isn't possible due to weather or other issues
The network functions 24/7 with emergency-trained staff at a hub providing eEmergency care to local sites via two-way video cameras. Rural practitioners can hit a red-alert button, allowing the remote emergency physician to “enter” the local emergency department through the camera. Through technology and consultation with rural professionals, the hub physician assists with diagnosis and treatment. The supportive nature of eEmergency models collegial relationships in larger facilities where it is understood that in emergency medicine, two heads are often better than one.
The sophisticated camera can zoom in and check pupil dilation and skin color, and allow the hub physician to view heart monitors and X-rays. Additionally, the hub can link to the patient's records through an integrated emergency medical record, allowing for seamless flow of information and diagnostic images. Facilities have two cameras to ensure complete coverage in events involving more than one critical patient.
Avera received a $6.3 million grant to pilot eEmergency over three years. The infrastructure for 25 sites is estimated at $850,000, not counting broadband. Avera was able to take advantage of connectivity and infrastructure that had already been developed by the organization.
The eEmergency hub is staffed 24/7 by physicians and nurses, who serve in their clinical roles, as well as in-staff training, policy development, and data management. Administrative and support staff are shared with other Avera eCare services to support consistent vision and implementation of services. eEmergency is supported by a team that provides IT, project management, communication, business and quality services in support of the daily clinical duties of the hub. An eCare medical director and eCare director lead the service line, site sales and implementation.
In just 4.5 months, as a result of eEmergency, local providers report fewer transfers, reducing the expense to the healthcare system and to patients. Keeping patients in the local hospital also supports the sustainability of the rural hospital and local community.
- Projected one-year savings for ground transfers for the first seven hospitals is estimated at $236,968.
- Avoided ground transfer costs translate to annual avoided air transfer costs of $856,642.
Avera combed through the stimulus law, but found that criteria for match dollars and need to support numbers of new jobs made requirements impossible for small rural hospitals. Avera has supported several other organizations, however, in their applications for funding for broadband services and regional extension centers, and is actively pursuing meaningful use incentives.
(Oct. 15, 2009-Feb. 28, 2010)
- 120 patients seen
- 34 transfers avoided
- 10 hospitals live in South Dakota and Iowa
- 4 hospitals contracted to go live
- 10 hospitals in decision-making process
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