Telemedicine Penetration and Consultation Among Rural Trauma Patients in Critical Access Hospital Emergency Departments in North Dakota


Trauma is the leading cause of death for Americans ages 1 to 44, and rural trauma patients have disproportionally high injury mortality rates. To help address the needs of rural trauma patients, emergency department (ED)-based telemedicine services are increasingly being used. The objective of this study was to describe the penetration of ED-based telemedicine in North Dakota critical access hospitals (CAHs), and to describe hospital and geographical factors that contribute to increased telemedicine utilization in rural ED trauma. This cohort study used the North Dakota Trauma Registry and Avera eEmergency subscription records and call log from 2008-2014. All North Dakota trauma patients were matched to the Avera eEmergency call log to evaluate whether telemedicine was consulted in their care. Hospital-level factors were obtained from the 2012 American Hospital Association survey.

During the study period, hospital subscription to a telemedicine provider increased to 81 percent of all North Dakota CAHs (n=29). Of the 35 percent of North Dakota CAH patients who presented to a telemedicine-capable ED between 2008-2014, 10.9 percent had telemedicine consulted as part of their care. No hospital-level or geographic variables were found to describe variation in subscription or usage.

Rural Telehealth Research Center
Nicholas Mohr, Karisa Harland, Elizabeth Chrischilles, Julie Donner, Amanda Bell, Dan Shane, Marcia Ward