Citation

Carmichael H, Dyamenahalli K, Duffy PS, Lambert Wagner A, Wiktor AJ. J. Burn Care Res. 2020; ePub(ePub): ePub.

Copyright

(Copyright © 2020, American Burn Association, Publisher Lippincott Williams and Wilkins)

DOI

10.1093/jbcr/iraa098

PMID

32588890

Abstract

Telemedicine technology can be used to facilitate consultations from non burn-trained referring providers. However, there is a paucity of evidence indicating these technologies influence transfer decisions and follow-up care. In 2016, our regional burn center implemented a mobile phone app, which allows a referring provider to send photos of the wound along with basic demographic and clinical data to the burn specialist. A retrospective review was performed on consults to our regional burn center from a Level I trauma center approximately 70 miles away with a shared electronic medical record. Patients were considered to be "down-triaged" if they could be managed locally or if transfer could occur via personal vehicle instead of ground or air ambulance transport. During the two-year study period, 126 consultations were made for thermal injuries. 87 patients (69%) were referred using the Burn App. Overall, 49 patients (39%) were transferred. When the subset of intermediate size (1-10% TBSA) burns were considered (n=48), the Burn App allowed for successful "down-triage" of 12 patients (33%) referred through the app. No patient referred without the app could be "down-triaged" (p=0.02). Although 57 patients (44%) were recommended for outpatient follow-up, only 42% followed up. A mobile app can be used to successfully triage patients with intermediate size burn injuries to a lower acuity of follow up and transfer mode. However only a minority of patients triaged to outpatient management actually follow up with a regional burn center. Telemedicine efforts should focus on improving not only initial triage, but also after care.

Language: en

Keywords

burns; consultation; mobile devices; patient referral; triage