Patients in rural hospitals can save thousands of dollars if local hospital is part of tele-emergency room network

Patients can save about $5,600 a year in transportation and other related expenses by staying in their local hospital and avoiding transfer to a larger hospital elsewhere, the study found. Those savings also included expenses such as missed time at work, lodging, and other personal expenses of accompanying friends or family members.

"Our study's primary goal was to identify the amount of money saved in situations when remote emergency medicine professionals can provide the necessary insight to help local providers avoid transfer of the patient," says Nabil Natafgi, research associate and adjunct assistant professor of health management and policy at the UI College of Public Health and study co-author. "The cost savings is significant and should help more rural health systems recognize the financial and non-financial value of telemedicine."

Tele-ER services are used by small, rural hospitals with limited emergency medicine resources to connect with hub hospitals staffed by full-time ER physicians and registered nurses. Health care providers at the hub use interactive audio-visual technology to examine the patient remotely and ask questions, and then determine whether the patient can be treated locally or should be transferred to a larger, better-equipped facility.

The study looked at more than 9,000 tele-ER encounters over the course of 52 months at 85 small, rural hospitals in seven states that are part of a network operated by Avera eCare, based in Sioux Falls, South Dakota. The researchers asked health care providers at the hub facility, Avera McKennan Hospital in Sioux Falls, how many patients they examined via tele-ER were able to remain in their local communities for treatment but likely would have been transferred to a larger hospital were it not for the remote exam.

The clinicians said nearly 1,200 patients likely would have been transferred if not for the tele-ER service.

The study found the use of tele-ER services does not save the local hospital money, because of the systems' high operating costs. But even after factoring in those costs, the study suggests the use of tele-ER saves about $3,800 in the larger economy, keeping that money in the local community.

Marcia Ward, PhD, professor and director of the Rural Telehealth Research Center (RTRC) at the UI, served as senior author on the paper. She said the importance of building an evidence base for similar telehealth applications in rural areas is noteworthy.

"The study points out that avoiding a transfer provides numerous other benefits," she said. "It keeps patients closer to their families and support networks, particularly elderly patients, and provides a means for which patients receive earlier diagnoses and intervention. Also, having a telehealth system increases the reputation of the rural hospital in its community."

The paper, "Using tele-emergency to avoid patient transfers in rural emergency departments: An assessment of costs and benefits," was published recently in the Journal of Telemedicine and Telecare. It was co-authored by Dan Shane, assistant professor of health management and policy; A. Clinton MacKinney, clinical assistant professor of health management and policy, all in the UI College of Public Health; and Amanda Bell of Avera Health, USA.