医疗专业人员

June 21, 2025

When a rural Minnesota crash ejected a child from a car, local paramedics transported the child to a critical access center. But the patient's injuries required more resources than were available there. The center's staff contacted Mayo Clinic's telemedicine emergency service (TeleEM) in Rochester and rapidly incorporated these additional care team members:

• Documentation nurse.
• Specialized pharmacist.
• Emergency medicine physician.
• Trauma response nurse.

"This center's staff were given an extremely challenging situation and felt better with at-elbow support through telemedicine," says David M. Nestler, M.D., M.S., TeleEM medical director at Mayo Clinic in Rochester, Minnesota.

Another scenario where telemedicine service can help is if a pregnant person delivers after a motor vehicle accident or a newborn presents after an unexpected at-home delivery, says Jennifer L. Fang, M.D., medical director for Mayo Clinic's Teleneonatology Program in Rochester. She notes healthcare professionals are sometimes uncomfortable resuscitating and stabilizing critically ill newborns.

"It's stressful," Dr. Fang says. "Stakes feel high for those who don't normally care for newborns, but our team can provide step-by-step guidance during the resuscitation. If you don't do something frequently, it can be challenging to achieve and maintain confidence in that skill set. We help ensure the resuscitation and stabilization meet the care standard and bring the anxiety level down."

Dr. Fang says teleneonatology can improve overall care quality and facilitate staff recruitment and retention in rural hospitals.

How telemedicine consults unfold

When a patient with a red- or yellow-level injury arrives, local professionals can immediately activate a multidisciplinary team by calling TeleEM.

Bart M. Demaerschalk, M.D., a neurologist at Mayo Clinic in Arizona, developed his site's telemedicine service 20 years ago, focusing on stroke. By 2011, Mayo Clinic opened a telestroke service in Florida and Minnesota. Then other Mayo Clinic disciplines emulated the program and began telemedicine service. Dr. Demaerschalk says recognition of need prompted his study of telemedicine and Mayo Clinic's program expansion.

"I observed if you had a stroke outside Tucson or Phoenix, you faced up to a multihour transport to the Phoenix emergency department," he says. "I began wondering why we were transporting patients many hours when we could bring experts to the patient with telemedicine."

Lindsey R. Asher, M.S., emergency medicine services manager at Mayo Clinic's campus in Rochester, says the COVID-19 pandemic accelerated telemedicine. The volume of patients who experienced trauma, went to a local emergency department and were transferred to Rochester also spurred telemedicine expansion to other centers, says Dr. Nestler.

"Telemedicine doesn't replace in-person care, but we can bring a lot of care through it," says Dr. Nestler. "We can join a resuscitation immediately by video and collaborate with on-site professionals, reducing burden for those in the room."

Typically, a message or a call triggers telemedicine service. On-call TeleEM specialists log into the telemedicine platform from any location, allowing each professional to see the patient and join the care team with the local professionals.

"At a Level 4 trauma center where I rotate, two nurses are always present, but no pharmacist," says Elizabeth C. Fogelson, M.D., TeleEM associate medical director at Mayo Clinic in Rochester, Minnesota. "A red-level trauma can easily overwhelm the facility's resources. Therefore, from Rochester, we support local care teams through a code, trauma or complex medical status."

How telemedicine benefits trauma professionals

The decision to contact TeleEM is up to each medical facility, says Dr. Nestler.

"We try to make it as convenient as possible," he says. "We want to bring resources we have in Rochester right to smaller hospitals, such as someone focusing solely on the patient's airway. We're set up for full trauma response. We acknowledge small hospitals cannot mount that support level without the volume and frequency we have."

Dr. Nestler says smaller hospitals should not hesitate to contact Mayo Clinic for telemedicine support. "Use us more so we can work together to do the best for patients," he says. "In Rochester, I routinely use help and talk to other physicians about what they'd do in a situation. I realize it feels different when calling someone you don't know at another site, but we want to collaborate."

Dr. Fogelson says she personally uses telemedicine support when working at a facility such as Mayo Clinic Health System in Cannon Falls, Minnesota.

"If there's a resuscitation or severe trauma while I'm at Cannon Falls, I use telemedicine," she says. "It helps a lot."

According to Dr. Fogelson, telemedicine and its extra personnel help the local team with:

• Medication.
  • Selection. The local team calling for telemedicine plus the larger center's team can share suggestions and choose medication together.
  • Prescription. Since the professionals at smaller centers may not be licensed to prescribe some medications, a physician at the larger center can prescribe.
  • Administration timing. When patients code, they require medication every three minutes. With telemedicine, a Rochester pharmacist keeps track of this and indicates when the local care team should administer medication.
• Collegial support. Having extra colleagues provides a team with whom to discuss the patient's condition and treatment and ensure nothing is missed.
• Treatment of patients who are immunocompromised. Rochester specialists can advise local staff in these situations.
• Call for transport. The Rochester telemedicine team can arrange patient transport to a higher level center.

Asher says use of telemedicine through Mayo Clinic's Rochester campus can alleviate constraints faced by small medical facilities, connecting them with additional resources and knowledge.

Dr. Nestler says using telemedicine also can help de-escalate tense and urgent care for injured patients.

"We want to reduce the cognitive burden and tasks involved in treating an injured patient, which is time-sensitive," he says. "The greatest emotional support is helping healthcare professionals not feel overwhelmed, say, for someone on the care team needing to step away from the patient to click boxes on a digital form. We can provide someone to enter orders so those at the bedside can do their jobs. And sometimes they can't enter orders, get blood gas or an X-ray without an emergency medicine physician."

How telemedicine benefits patients

Telemedicine services also benefit patients' care in multiple ways:

• Enlarges the team. Telemedicine offers more eyes and ears involved in patients' care.
• Allows for precision medicine. A specialty pharmacist at a large center can help tailor patients' medications to their specific needs.
• Prevents unnecessary transfer. A larger team can jointly determine if patients can stay at their local emergency departments, avoiding unnecessary transfers. This also allows quicker treatment.
• Keeps patient's support system local. If an injured patient in a rural area is transported to a larger center miles away, that often means travel for local family and friends. The telemedicine team physician can speak to family and friends, if requested. Dispatch can send a community paramedic to a patient's home and from there, connect with Mayo Clinic telemedicine.
• Lowers patient's total bill. When treated by telemedicine, patients are billed the Mayo Clinic physician fee at a reduced telemedicine rate, and the patient is not billed for a Rochester facility visit.
• Provides services unavailable locally. At smaller centers, some services are unavailable, such as specialized guidance through anticoagulation reversal. This procedure is costly and complex, and the opinion of a specialty pharmacist at a large center can be useful. Another example is obstetrician and neonatologist direction for a hospital without OB services.
• Offers 24/7 dedicated service. While many centers do not provide round-the-clock coverage, telemedicine can provide middle-of-the-night care. Telemedicine offers coverage 24/7 with an emergency medicine physician and an allied health team, expanding the team with other professionals as appropriate. In Rochester, Mayo Clinic has a dedicated telemedicine room with staff present between 7 a.m. and 1 a.m. An administrator is available round-the-clock, if needed.

"I'm in emergency medicine, and I've only performed three deliveries in my career," says Dr. Fogelson. "So working at a site without an obstetrician is challenging, and telemedicine provides specialized help."

Asher says payers typically cover most of patients' costs for telemedicine services.

Outcomes

Asher says that directly connecting patient outcomes to telemedicine is difficult. However, TeleEM is studying value measurement. Dr. Nestler says TeleEM leaders are researching optimal telemedicine resource use, especially providing exactly the right number and type of services needed while meeting American College of Surgeons' requirements.

"We want patients to have exactly the amount of care needed — no more, no less," Dr. Nestler says.

Asher also says avoiding unnecessary patient transport to Rochester is a better outcome for the patient and the medical centers involved. If the patient requires transfer after telemedicine consult, the background gained by the Rochester professionals involved can improve their ability to provide care quickly when the patient arrives.