Elyse Watkins, DHSc, PA-C, DFAAPA
The purpose of this article is to review the ability of medical providers in neurosurgery to
implement telemedicine encounters in their current practice in an effort to reduce costs to
patients and hospitals and improve the quality and accessibility of care, for patients diagnosed
with traumatic brain injuries (TBI) in outlying or rural medical facilities.
A PubMed literature search was conducted with search terms including, but not limited to; telemedicine, telehealth, neurosurgery, neurotrauma, traumatic brain injury, TBI, healthcare costs, transfer, outlying medical facility, medical transfer costs, and rural care. All articles reviewed were published in or after 2002. There was a total of 16 articles reviewed and our of those articles, eleven relevant articles were grouped for analysis if they were substantially similar in areas related to the use of telemedicine in the treatment of TBIs.
In the aggregate, eleven relevant articles were selected that indicate that medical providers in the field of neurosurgery at a high-level trauma facility can often safely and effectively manage patients diagnosed with TBIs through a coordinated telemedicine encounter with a medical provider at the outlying or rural medical facility. Furthermore, research indicates that patients with a mild TBI diagnosis that are not transferred from an outlying facility to a larger trauma facility, can save on travel time, will not have to take as much time off work, and will likely have a better support system since they will be able to stay closer to their home and families.6 Hospitals can save on costs as well, as a recent study conducted by the Veterans Health Administration (VHA) found that telemedicine encounters result in a 25% reduction in hospital days and a 19% reduction in hospital admissions. Overall, the telemedicine model related to the treatment of TBIs in outlying or rural areas results in cost savings of $1,937 per patient.
Although the body of literature related to this topic is not large, based on the studies reviewed, the implementation of telemedicine to treat patients with TBIs in outlying or rural areas will likely reduce costs to patients and hospitals and improve the quality and accessibility of care. More information is required from future telemedicine studies related to TBIs, such as the criteria medical providers should use to establish when a TBI patient should be transferred; this may include age, medication history, type of hemorrhage, neurological exam, etc. With established criteria, outlying or rural medical facilities that lack neurosurgical coverage can confidently proceed with the implementation of telemedicine for certain TBI patients.
Evans RM. Telemedicine to Treat Traumatic Brain Injury in Outlying and Rural Medical Facilities: A Review of Current Literature. University of Lynchburg DMSc Doctoral Project Assignment Repository. 2019; 1(4).
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