Process improvement using telemedicine consultation to prevent unnecessary interfacility transfers for low-severity blunt head trauma
Objective Mild traumatic brain injuries (MTBI) associated with intracranial haemorrhage are commonly transferred to tertiary care centres. Recent studies have shown that transfers for low-severity traumatic brain injuries may be unnecessary. Trauma systems can be overwhelmed by low acuity patients j...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2023-03-01
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| Series: | BMJ Open Quality |
| Online Access: | https://bmjopenquality.bmj.com/content/12/1/e002012.full |
| _version_ | 1797769131724898304 |
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| author | Gayla Miles Christopher Shank Ann Quinlan Jennifer Cavender |
| author_facet | Gayla Miles Christopher Shank Ann Quinlan Jennifer Cavender |
| author_sort | Gayla Miles |
| collection | DOAJ |
| description | Objective Mild traumatic brain injuries (MTBI) associated with intracranial haemorrhage are commonly transferred to tertiary care centres. Recent studies have shown that transfers for low-severity traumatic brain injuries may be unnecessary. Trauma systems can be overwhelmed by low acuity patients justifying standardisation of MTBI transfers. We sought to evaluate the impact of telemedicine services on mitigating unnecessary transfers for those presenting with low-severity blunt head trauma after sustaining a ground level fall (GLF).Method A process improvement plan was developed by a task force of transfer centre (TC) administrators, emergency department physicians (EDP), trauma surgeons and neurosurgeons (NS) to facilitate the requesting EDP and the NS on-call to converse directly to mitigate unnecessary transfers. Consecutive retrospective chart review was performed on neurosurgical transfer requests between 1 January 2021 and 31 January 2022. A comparison of transfers preintervention and postintervention (1 January 2021 to 12 September 2021)/(13 September 2021 to 31 January 2022) was performed.Results The TC received 1091 neurological-based transfer requests during the study period (preintervention group: 406 neurosurgical requests; postintervention group: 353 neurosurgical requests). After consultation with the NS on-call, the number of MTBI patients remaining at their respective ED’s with no neurological degradation more than doubled from 15 in the preintervention group to 37 in the postintervention group.Conclusion TC-mediated telemedicine conversations between the NS and the referring EDP can prevent unnecessary transfers for stable MTBI patients sustaining a GLF if needed. Outlying EDPs should be educated on this process to increase efficacy. |
| first_indexed | 2024-03-12T21:04:29Z |
| format | Article |
| id | doaj.art-e313cc0b0f344f5b975433ed4ce826c2 |
| institution | Directory Open Access Journal |
| issn | 2399-6641 |
| language | English |
| last_indexed | 2024-03-12T21:04:29Z |
| publishDate | 2023-03-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Quality |
| spelling | doaj.art-e313cc0b0f344f5b975433ed4ce826c22023-07-30T18:25:06ZengBMJ Publishing GroupBMJ Open Quality2399-66412023-03-0112110.1136/bmjoq-2022-002012Process improvement using telemedicine consultation to prevent unnecessary interfacility transfers for low-severity blunt head traumaGayla Miles0Christopher Shank1Ann Quinlan2Jennifer Cavender3Trauma, Texas Health Harris Methodist Hospital Fort Worth, Fort Worth, Texas, USANeuro-Trauma, Texas Health Harris Methodist Hospital Fort Worth, Fort Worth, Texas, USATrauma, Texas Health Harris Methodist Hospital Fort Worth, Fort Worth, Texas, USATransfer Center, Texas Health Resources, Arlington, Texas, USAObjective Mild traumatic brain injuries (MTBI) associated with intracranial haemorrhage are commonly transferred to tertiary care centres. Recent studies have shown that transfers for low-severity traumatic brain injuries may be unnecessary. Trauma systems can be overwhelmed by low acuity patients justifying standardisation of MTBI transfers. We sought to evaluate the impact of telemedicine services on mitigating unnecessary transfers for those presenting with low-severity blunt head trauma after sustaining a ground level fall (GLF).Method A process improvement plan was developed by a task force of transfer centre (TC) administrators, emergency department physicians (EDP), trauma surgeons and neurosurgeons (NS) to facilitate the requesting EDP and the NS on-call to converse directly to mitigate unnecessary transfers. Consecutive retrospective chart review was performed on neurosurgical transfer requests between 1 January 2021 and 31 January 2022. A comparison of transfers preintervention and postintervention (1 January 2021 to 12 September 2021)/(13 September 2021 to 31 January 2022) was performed.Results The TC received 1091 neurological-based transfer requests during the study period (preintervention group: 406 neurosurgical requests; postintervention group: 353 neurosurgical requests). After consultation with the NS on-call, the number of MTBI patients remaining at their respective ED’s with no neurological degradation more than doubled from 15 in the preintervention group to 37 in the postintervention group.Conclusion TC-mediated telemedicine conversations between the NS and the referring EDP can prevent unnecessary transfers for stable MTBI patients sustaining a GLF if needed. Outlying EDPs should be educated on this process to increase efficacy.https://bmjopenquality.bmj.com/content/12/1/e002012.full |
| spellingShingle | Gayla Miles Christopher Shank Ann Quinlan Jennifer Cavender Process improvement using telemedicine consultation to prevent unnecessary interfacility transfers for low-severity blunt head trauma BMJ Open Quality |
| title | Process improvement using telemedicine consultation to prevent unnecessary interfacility transfers for low-severity blunt head trauma |
| title_full | Process improvement using telemedicine consultation to prevent unnecessary interfacility transfers for low-severity blunt head trauma |
| title_fullStr | Process improvement using telemedicine consultation to prevent unnecessary interfacility transfers for low-severity blunt head trauma |
| title_full_unstemmed | Process improvement using telemedicine consultation to prevent unnecessary interfacility transfers for low-severity blunt head trauma |
| title_short | Process improvement using telemedicine consultation to prevent unnecessary interfacility transfers for low-severity blunt head trauma |
| title_sort | process improvement using telemedicine consultation to prevent unnecessary interfacility transfers for low severity blunt head trauma |
| url | https://bmjopenquality.bmj.com/content/12/1/e002012.full |
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