Relationship Building is Key to Success in Rural Tele-Emergency

| URAC Staff
Emergency medicine team photo

There are red “easy buttons” in 180 Critical Access Hospitals across 14 states. But they have nothing to do with ordering office supplies.

These eCARE Emergency buttons are installed in a convenient location in each emergency department room. With one press, providers at the partner hospitals connect directly with board-certified, emergency physicians and critical care nurses at the Avera virtual hospital hub.

Access to specialty care is vital because 99 percent of the partners in the Avera eCARE Emergency network are remote rural hospitals. For rural hospitals, tele-emergency has the potential to result in a net savings of $3,823 per avoided patient transfer. That’s according to a 2017 study published in the Journal of Telemedicine and Telecare.

Brian Skow, M.D.: “It’s about the relationships.”

Hospitals in the Avera network connect with secure, interactive, high-definition video and audio equipment and software. The setup is impressive. But it’s just part of the solution, according to Brian Skow M.D. FACEP, chief medical officer at Avera eCARE.

“It's not about the technology,” Dr. Skow says. “It's about the relationships and this is our passion.”

Relationship building starts before a new rural hospital joins Avera’s network. Skow and his team first visit the facility to meet the medical staff and assess their needs. They discuss operations extensively with physicians, nurses and mid-level practitioners. Based on these conversations, the Avera team can usually determine how well the partnership will work, or not.

 “We do not want to go in if there is no interest in peer-to-peer support,” said Skow, who will present “Tele-Emergency on the Prairie: Lives Saved” at the Telemed Leadership Forum 2019: Transforming Healthcare Delivery in Washington, D.C., April 3-5, 2019.

If the partnership moves forward, Avera tailors a specific suite of tele-emergency services for each hospital.

Deeper relationships and trust continue to build during several days of go-live training, followed by 30-day and 90-day training revisits, and at least twice a year thereafter. The camaraderie develops further during twice-daily camera checks conducted by Avera nurses.

“We get to know our partners by first name,” Skow said. “We know if they have a child graduating from high school or if someone is a new grandmother.”

Both personal and high-speed connections are critical to making these relationships work. The victim of a rattlesnake bite assisted by the Avera team could attest to this fact.

With a dangerous rattlesnake bite, seconds can make the difference between a successful and tragic outcome – but this patient had further complications with a rare allergic reaction to the anti-venom. Two family physicians and two of Avera eCare’s flight team members were at the patient’s bedside, with Skow providing guidance through telemedicine for a complicated procedure.

To circumvent a blocked airway, Skow guided one of the family doctors through the procedure to make an incision in the cricothyroid membrane, which lies between the thyroid and cricoid cartilages, followed by inserting a tracheostomy tube, which allowed ventilation. It was the first telemedicine-assisted cricothyroidotomy, Dr. Skow said.

The success of this complicated procedure illustrates the importance of the relationship building between the rural hospital physicians and Avera’s specialists. Without the prior months of training and trust-building, the outcome may have been quite different.


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