Insist on telemedicine at your regional trauma center

If you’re an ED manager at a rural health care facility, you should insist that the regional trauma center serving your areas has telemedicine facilities, advises Rifat Latifi, MD, associate professor of clinical surgery, director of surgical critical care and associate director of trauma and critical care, and telesurgery and international affairs at the Arizona Health Sciences Center in Tucson.

Not only are the benefits to patient care undeniable, argues Latifi, but the cost of a system can be recovered with just one or two cases.

"The most expensive [telemedicine] system I’ve seen costs about $37,000," he notes. "But such a system will save you a lot of money by [avoiding] unnecessary transfers."

Latifi recalls a recent case in which a patient had been pinned under a car. When taken to the ED at Southeast Arizona Medical Center in Douglas, he had a significant laceration in his forehead.

"If I did not have a way to see this guy [through his teletrauma system], I would have said, Put him in a helicopter and send him here,’" he notes. "It’s 100 miles, which by air costs close to $15,000."

However, Latifi says he was able to actually visualize the wound itself, advise the ED doc to get a CT scan, and if there was no brain injury [which turned out to be the case], to put him in ambulance for transfer.

"I had another patient the other day with a gunshot wound to the chest," he continues. "When we learned [remotely] there was no hemothorax, we determined the patient could be managed over there. In the past, a patient with the same injury would have meant an automatic helicopter trip here and another $15,000."

In addition, Latifi notes, since trauma center patients typically are not paying patients, the hospital also saves money by avoiding treating patients who have been transferred unnecessarily.

There are other savings realized which, while not directly related to the hospital, are important nonetheless, he adds.

"Think of what the family goes through when you transfer an injured patient," Latifi offers. "It’s relatively easy for us: You put them in an ambulance or a helicopter, and there you go — but there are 15 cousins, brothers, wives, children who also need to travel. Just imagine what we are saving society!"

For all these reasons, he explains, "If I was an ED manager in a small hospital anywhere in the country, I would insist the place I send patients to — or receive patients from — have a video teleconference system. There’s no reason they should not have one."

The bottom line, Latifi points out, is that it’s just not that large an investment for a trauma center.

"And even if they don’t get a [state] grant, as we did, and have to buy it, since they would likely save a lot of money on the first one or two patients who are not transferred there, it would pay for itself in the first week," he concludes.