Preliminary evidence suggests that teletrauma programs are associated with improvements in the quality of initial trauma care, shorter transfer time to advanced trauma centers for severely injured patients and decreased rates of potentially unnecessary transfers to advanced trauma centers, which leads to substantial cost savings.Nearly 30 million Americans lack timely access to a Level I or Level II trauma center, but patients in rural areas face the most dangerous gaps in trauma care. The lack of clinical expertise in a time-sensitive and complex clinical decision-making process can lead to worse clinical outcomes for patients. Researchers at the University of Alabama at Birmingham recently published an article titled “Teletrauma Use in US Emergency Departments” in the Journal of the American Medical Association that advocates for a solution to this problem — teletrauma.
Teletrauma is a promising approach to improve access to health care expertise using remote consultation. It can bring expertise from a trauma center to injured patients in a non-trauma center. However, researchers say teletrauma is currently being underutilized. In a national survey study of 4,512 emergency departments nationwide, only 8 percent of those emergency departments reported using teletrauma in 2020.
“Teletrauma care has the potential to help save lives and improve care coordination for injured patients located far away from major trauma centers,” said Mohammad Zain Hashmi, M.D., an assistant professor in the UAB Division of Trauma and Acute Care Surgery. “That means that patients can receive better trauma care closer to their home — severely injured patients can be treated and transferred quickly to trauma centers, while those with less severe injuries can avoid high costs and the inconvenience associated with ambulance transfers to distant trauma centers.”
During a teletrauma consult, trauma and subspeciality surgeons remotely connect to emergency department providers on-site to provide clinical support during the early care of a patient who has experienced an injury. Teletrauma has been used to assist emergency care practitioners in providing pre-hospital care. Preliminary evidence suggests that teletrauma programs are associated with improvements in the quality of initial trauma care, shorter transfer time to advanced trauma centers for severely injured patients and decreased rates of potentially unnecessary transfers to advanced trauma centers, which leads to substantial cost savings.
Telemedicine is an already established vehicle for health care delivery, especially in underserved areas. However, teletrauma has not been formally adopted and widely integrated as a strategy to improve rural trauma systems.
A recent workgroup, led by Hashmi and Caroline Park, M.D., a trauma surgeon at the University of Texas Southwestern Medical Center at the American College of Surgeons Committee on Trauma, published a special article in the Journal of the American College of Surgeons titled “Using Teletrauma to Improve Access to Trauma Care in the US: A Call for Action,” which makes the case for wider use of teletrauma, highlights barriers to progress and provides recommendations for future work.
“With the expansion of telehealth, barriers common to any telehealth program either have been resolved or at least have some precedents available to inform teletrauma implementation,” Hashmi said. “However, trauma-specific barriers, such as evidence-based clinical workflows and staffing models, have remained largely unresolved. Currently, there are no telehealth implementation toolkits, and there is no consensus among the trauma care community regarding the standards and verification of teletrauma programs. These seem to be the major barriers hindering progress in this area.”
Hashmi and his team recommend addressing some of these barriers by defining priority research areas in teletrauma, developing teletrauma implementation toolkits to standardize teletrauma care, and ensuring representation from rural providers as well as patients and patient advocates to drive both research and programmatic growth of teletrauma programs.
Hashmi is now leading national, multidisciplinary efforts, to both study nuances of delivering trauma care remotely and develop optimal strategies to more widely implement teletrauma, while embarking on local initiatives such as developing the Alabama Teletrauma Program.
Real-time, two-way, audiovisual communication would allow UAB trauma surgeons and subspecialists to become part of the patient’s care team from afar, providing expert, timely bedside care. Trauma surgeons would be able to advise their emergency medicine colleagues, helping make early, important decisions aimed at improving outcomes. This expanded care team can determine whether a patient needs to be transferred to a Level I trauma center or the patient would be better served with alternative care pathways such as outpatient evaluation or a local hospital admission with additional expert support available via telerounding. In addition to reviewing scans or consulting with doctors, trauma surgeons can have face-to-face conversations with patients if possible, establishing a doctor-patient relationship.
Teletrauma will go hand in hand with the Rural Trauma Team Development course offered by the UAB Marnix E. Heersink School of Medicine that is designed to empower rural hospitals to evaluate and resuscitate the seriously injured and to determine whether the patient needs to be transferred to a hospital that can offer a higher level of care. Hashmi feels hopeful that modernizing trauma care with a well-integrated telemedicine component will lead to a more inclusive trauma system and reduce disparities in rural trauma care.