A statewide teleradiology system reduces radiation exposure and charges in transferred trauma patients

Justin J J Watson; Alexis Moren; Brian Diggs; Ben Houser; Lynn Eastes; Dawn Brand; Pamela Bilyeu; Martin Schreiber; Laszlo Kiraly

doi:10.1016/j.amjsurg.2016.01.010

A statewide teleradiology system reduces radiation exposure and charges in transferred trauma patients

Am J Surg. 2016 May;211(5):908-12. doi: 10.1016/j.amjsurg.2016.01.010. Epub 2016 Feb 23.

Authors

Justin J J Watson¹, Alexis Moren², Brian Diggs², Ben Houser², Lynn Eastes², Dawn Brand², Pamela Bilyeu², Martin Schreiber², Laszlo Kiraly²

Affiliations

¹ Department of Surgery, Oregon Health and Science University, L611, 3181 SW Sam Jackson Park Road Portland, OR 97239, USA. Electronic address: watsonju@ohsu.edu.
² Department of Surgery, Oregon Health and Science University, L611, 3181 SW Sam Jackson Park Road Portland, OR 97239, USA.

PMID: 27012476
DOI: 10.1016/j.amjsurg.2016.01.010

Abstract

Background: Trauma transfer patients routinely undergo repeat imaging because of inefficiencies within the radiology system. In 2009, the virtual private network (VPN) telemedicine system was adopted throughout Oregon allowing virtual image transfer between hospitals. The startup cost was a nominal $3,000 per hospital.

Methods: A retrospective review from 2007 to 2012 included 400 randomly selected adult trauma transfer patients based on a power analysis (200 pre/200 post). The primary outcome evaluated was reduction in repeat computed tomography (CT) scans. Secondary outcomes included cost savings, emergency department (ED) length of stay (LOS), and spared radiation. All data were analyzed using Mann-Whitney U and chi-square tests. P less than .05 indicated significance. Spared radiation was calculated as a weighted average per body region, and savings was calculated using charges obtained from Oregon Health and Science University radiology current procedural terminology codes.

Results: Four-hundred patients were included. Injury Severity Score, age, ED and overall LOS, mortality, trauma type, and gender were not statistically different between groups. The percentage of patients with repeat CT scans decreased after VPN implementation: CT abdomen (13.2% vs 2.8%, P < .01) and cervical spine (34.4% vs 18.2%, P < .01). Post-VPN, the total charges saved in 2012 for trauma transfer patients was $333,500, whereas the average radiation dose spared per person was 1.8 mSV. Length of stay in the ED for patients with Injury Severity Score less than 15 transferring to the ICU was decreased (P < .05).

Conclusions: Implementation of a statewide teleradiology network resulted in fewer total repeat CT scans, significant savings, decrease in radiation exposure, and decreased LOS in the ED for patients with less complex injuries. The potential for health care savings by widespread adoption of a VPN is significant.

Keywords: Charges; Decreased; Radiation; Reduction; Statewide; Teleradiology.

MeSH terms

Adult
Cost Savings*
Emergency Service, Hospital / economics
Female
Humans
Male
Oregon
Patient Transfer*
Radiation Exposure / prevention & control*
Registries
Retrospective Studies
Teleradiology / economics*
Teleradiology / methods*
Tomography, X-Ray Computed / economics
Tomography, X-Ray Computed / statistics & numerical data
Trauma Centers / organization & administration
Wounds and Injuries / diagnosis*
Wounds and Injuries / therapy