Feb. 07, 2020

In a Level III or IV trauma center or critical access hospital, a patient presenting with a serious injury from a car crash, farm implement, fall, gunshot or stabbing likely means it's "all hands on deck." This may present some of the following challenges: limited care team resources, unique cases, ambiguous direction for care, more-complex pharmacologics and equipment barriers.

Limited care team resources

Your team may find it doesn't have enough personnel for real-time documentation while using all human resources available to save the patient's life.

Unique cases

The case may involve a high-acuity patient with a relatively uncommon injury for your facility, as you see lower volume and few high-risk patients.

Ambiguous direction for care

Best practices or decision-making may be relatively unclear for this patient, such as whether a tibia fracture can be treated locally or if the patient needs to go to Mayo Clinic's campus in Rochester, Minnesota, for surgery.

More-complex pharmacologics

Depending on the patient's medication history or coexisting conditions, pharmacological management of the patient's injuries may be complicated — such as a patient taking anticoagulants — and present questions personnel at your facility may not encounter frequently.

Equipment barriers

Though much equipment has been standardized among trauma sites in Southern Minnesota, some variance remains. You may not have a particular device you need for a trauma case; or you may have it available, yet it is rarely used and feels unfamiliar.

If you find yourself in any of these scenarios or similar where you could use help on occasion, TeleEM, a new emergency telemedicine consult service with nurses and physicians at Mayo Clinic, may be beneficial. TeleEM launched in October 2019.

"If you don't see these types of high-acuity cases frequently, we can provide real-time bedside consultation and guidance and help offload cognitive burden," says Christopher S. Russi, D.O., an emergency medicine physician at Mayo Clinic in Rochester, Minnesota, and the chair of the Midwest Department of Emergency Medicine Telehealth and Innovation.

Process for TeleEM use

To activate TeleEM, any nurse or physician at your facility may call the Midwest Admission and Transfer Center at 507-255-2910, where personnel will page the TeleEM physician. One of 17 emergency department nurses in the TeleEM service is available to help when requested. The Rochester provider will then log in to the TeleEM system and interact with the provider on-site as well as the patient. The patient will be billed a nominal fee for the service.

Approach with TeleEM

When TeleEM is activated, you continue to be in charge of the patient's care. A Mayo Clinic nurse or physician is present during the patient's treatment and may speak to the patient directly, but he or she fills an adjunct care role, rather than the role of primary caregiver.

Darla R. Meurer, M.S.N., R.N., nurse manager of the telehealth nursing team at the Rochester campus emergency department, notes, "The main question to the local provider and nurses asked by the TeleEM physician and nurse in Rochester is, 'How can we help you?'"

Dr. Russi agrees: "We work really hard to be kind and helpful, and add value. Though some may picture telemedicine as impersonal, it's not at all robotic. You're not talking to a smart speaker, but a human being."

TeleEM benefits for local sites

Dr. Russi cites a number of advantages to smaller trauma centers and critical care hospitals with TeleEM service use:

Care- and transfer-related consult

The TeleEM service allows a nurse, a tele-emergency medicine pharmacist or an emergency medicine physician to talk with you about any concerns or questions regarding the patient's case, or virtually go to the bedside with you and interact with the patient.

Nursing assistance with documentation

The TeleEM nurse is able to help with completing real-time documentation and offer nursing guidance while you're most needed for immediate patient resuscitation and stabilization. An emergency nurse in Rochester completes this documentation while you provide care for a leveled trauma patient. Accuracy of documentation is verified through a review by the local nursing team afterward. This service is in a pilot phase with Mayo Clinic Health System in Springfield, Minnesota, and nursing support is planned to expand to additional sites.

Cognitive burden offload

Trying to resuscitate and stabilize a patient whose life is in danger while your mind is whirring with details of transport and transfer can be difficult. Letting the TeleEM providers take care of these details for you can allow you to remain at the bedside and focus on the situation at hand.

Rapid resourcing

If you are dialoguing with a Mayo Clinic nurse or physician via TeleEM, he or she can act quickly — while you continue caring for the patient — to get you any needed resources such as a helicopter, a critical care ground team or a specialist in care relevant to the case.

Relationship building

Working together through telemedicine increases interaction between local sites and Mayo Clinic. Meurer says so far, nurses on her team who've participated in telehealth have enjoyed helping and building relationships with staff at other facilities. "These are our team members in other sites," says Meurer. "Many times they transfer patients to us, and I think our relationship with them is very important and positively benefits the patient's care."

The cooperation in a TeleEM session also allows the Mayo Clinic trauma team to be well briefed on the case by a telemedicine colleague before a transferred patient arrives, which is advantageous for best preparation.

Cost avoidance

With a trauma such as a motorcycle crash, a patient who can be seen entirely in the local setting through a TeleEM session represents a cost savings for the patient and facilities involved. Significant transportation and higher level care hospital costs can be averted.

Higher throughput

Dr. Russi and colleagues continue to collect data on TeleEM service efficiency and already see a trend toward faster care with TeleEM.

Satisfaction and convenience for families

If transfer is deemed unnecessary, satisfaction for the patient's family improves. Staying in the community can be facilitated by a virtual consult with a local provider and a Mayo Clinic specialist, amplifying quality and lessening unneeded transfer. Mayo Clinic physicians consulting by TeleEM also can talk with the family about the patient's status while the local physician provides care, achieving the ideal of family communication simultaneous to trauma care. If there is nothing more that can be done for the patient, the TeleEM physician or nurse can help families feel as comfortable as possible with the patient's status.

"You can call for anything — consider us your friends who are ready to give help and advice, another set of eyes on the patient's case," says Dr. Russi. "It's a culture shift — a different model of care. I've noted when people start to use us, however, they start calling more frequently."