Pictures Do Influence the Decision to Transfer: Outcomes of a Telemedicine Program Serving an Eight-State Rural Population

Abstract

Triaging burn patients is a daunting task because burn injuries are rare; this inexperience leads to uncertainty in treatment and referral algorithms. Our regional burn center's catchment area includes eight states. Outlying facilities consult via telephone through the medical center's transfer center. Referring provider assessments of depth or size of injury infrequently correlates with burn provider's assessments. This causes over- and under-triage of patients managed outside of burn centers. A quality improvement telemedicine project was developed to allow burn providers to review photos with referring providers to determine best management, provide pertinent education, and initiate appropriate and timely resuscitation. Details tracked include date of service, consulting provider, follow-up education offered, and whether the image reviewed changed or confirmed the requested plan of care. Of the 155 cases between January 2017 and August 2018, 24.5% of patient images changed the initial transfer decision, and 75.5% confirmed the initial plan of care. Of the cases requiring change of plan, 60.5% were down-triaged to outpatient care and 39.5% were up-triaged to transfer. Implementation of this telemedicine program has increased efficiency of resource utilization, timely resuscitation, appropriate transfer of patients requiring admission, and real-time education. Findings suggest advanced practice providers' assessments are similar to those of referring physicians. These observations may have significant implications on Emergency Medical Treatment and Labor Act (EMTALA) guidelines defining physician to physician consultation and support efficient use of available resources. Telemedicine facilitates access to specialized care and improves fiscal responsibility.