Let the Little Brother Watch Big Brother

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Let the Little Brother Watch Big Brother

• How to Improve Utilization of a Teletrauma Network

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Objectives

• Challenges of rural trauma care

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Objectives

• Challenges of rural trauma care
• Role of telemedicine

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Objectives

• Challenges of rural trauma care
• Role of telemedicine
• UVM Teletrauma program

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Objectives

• Challenges of rural trauma care
• Role of telemedicine
• UVM Teletrauma program
• Limitations

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• Level I trauma center
• Catchment 1 million

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• Level I trauma center
• Catchment 1 million
• Chittenden county - 150,000

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• Level I trauma center
• Catchment 1 million
• Chittenden county - 150,000
• Vermont - 620,000

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• Level I trauma center
• Catchment 1 million
• Chittenden county - 150,000
• Vermont - 620,000
• Davidson County 550,000

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Rural TraumaThe Problem

• 20 of population resides in rural areas

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Rural SurgeryThe Scope

• 20 of population resides in rural areas

http//www.census.gov/prod/2002pubs/censr-4.pdf
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Rural SurgeryThe Scope

• 20 of population resides in rural areas

http//www.census.gov/prod/2002pubs/censr-4.pdf
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Rural SurgeryThe Scope

• 20 of population resides in rural areas

http//www.census.gov/prod/2002pubs/censr-4.pdf
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Rural TraumaThe Problem

• 20 of population resides in rural areas
• Rural Crash Fatality rate gt 2 x Urban

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Rural TraumaThe Problem

• 20 of population resides in rural areas
• Rural Crash Fatality rate gt 2 x Urban
• ISS Adjusted risk of mortality for Rural MVCs
  1.9
• 28,859 MVCs in Nebraska 1996-1999

Mulleman RL et al. Academic Emergency Medicine
2004 11(5) 544-545 Rural Emergency Medical
Services Special Report US. Washington, DC
Congressional Office of Technology Assessment
1989. Publication OTA-H-445.
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UVM Teletrauma Program
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UVM Teletrauma Program

• Established April 2000

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UVM Teletrauma Program

• Established April 2000

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UVM Teletrauma Program

• Established April 2000
• Video teleconferencing Units Rural E.D.s

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• 3 ISDN Lines
• 384 kbps

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UVM Teletrauma Program
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UVM Teletrauma Program
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UVM Teletrauma Program
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Reasons for Decreased Utilization of Teletrauma
System
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Reasons for Decreased Utilization of Teletrauma
System

• Physician turnover

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Reasons for Decreased Utilization of Teletrauma
System

• Physician turnover
• Lack of familiarity with telemedicine

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Reasons for Decreased Utilization of Teletrauma
System

• Physician turnover
• Increased comfort with trauma

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Reasons for Decreased Utilization of Teletrauma
System

• Physician turnover
• Increased comfort with trauma
• Aggressive ATLS training

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Reasons for Decreased Utilization of Teletrauma
System

• Physician turnover
• Increased comfort with trauma
• Perception of Level I trauma center as Big
  Brother

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Reasons for Decreased Utilization of Teletrauma
System

• Physician turnover
• Increased comfort with trauma
• Perception of Level I trauma center as Big
  Brother
• QI review

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Hypothesis

• If we allow rural E.D.

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Hypothesis

• If we allow rural E.D. (Little Brother)

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Hypothesis

• If we allow rural E.D. (Little Brother) to
  observe the care of the trauma patient at the
  Level I trauma center

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Hypothesis

• If we allow rural E.D. (Little Brother) to
  observe the care of the trauma patient at the
  Level I trauma center (Big Brother)

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Hypothesis

• If we allow rural E.D. (Little Brother) to
  observe the care of the trauma patient at the
  Level I trauma center (Big Brother)
• It will soften the stigma that Big Brother is
  watching

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Hypothesis

• If we allow rural E.D. (Little Brother) to
  observe the care of the trauma patient at the
  Level I trauma center (Big Brother)
• It will soften the stigma that Big Brother is
  watching
• It will improve utilization of the teletrauma
  system

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Methods

• Equip our Level I Trauma Center resuscitation
  room with a video teleconferencing unit

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Methods

• Equip our Level I Trauma Center resuscitation
  room with a video teleconferencing unit
• Notify and connect to the originating E.D. once
  patient arrives

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Let Little Brother Watch Big Brother
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Let Little Brother Watch Big Brother
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Let Little Brother Watch Big Brother

• Did this eliminate the Big Brother stigma?

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Let Little Brother Watch Big Brother

• Did this eliminate the Big Brother stigma?
• Was this simply a way to promote awareness of the
  technology?

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Let Little Brother Watch Big Brother

• Limitations
• Change of shift
• Busy referring provider / E.D.
• Unrelated patient occupying telemedicine capable
  bed

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Summary

• Rural Trauma presents unique challenges
• Utilization of the teletrauma program at our
  institution attenuated over time
• Allowing Little Brother to watch Big Brother
  may result in increased utilization
• Barriers still exist to widespread utilization