Eli Saslow, a Washington Post reporter, tells us, “The number of ER patients in rural areas has surged by 60 percent in the past decade, even as the number of doctors and hospitals in those places has declined by up to 15 percent. Dozens of stand-alone ERs are fighting off bankruptcy. Hundreds of critical-access hospitals either can’t find a doctor to hire or can’t afford to keep one on site. Often it is a nurse or a physician assistant left in charge of a patient.”[1]
“If anything defines the growing health gap between rural and urban America, it’s the rise of emergency telemedicine in the poorest, sickest, and most remote parts of the country, where the choice is increasingly to have a doctor on screen [from a nearby urban hospital] or no doctor at all.”
An example of such a telemedicine emergency service is Avera eCare in Sioux Falls, SD, which provides a telemedicine center providing remote emergency care for 179 hospitals over 30 Midwestern states. “Physicians for Avera eCare work out of high-tech cubicles instead of exam rooms. They wear scrubs to look the part of traditional doctors on camera, even though they never directly see or touch their patients. They respond to more than 15,000 emergencies each year by using remote-controlled cameras and computer screens. . . .”
“In less than a decade, . . . [this] virtual hospital has grown from a few part-time employees working out of a converted storage room into one of the country’s most dynamic 24-hour ERs, where a rural health-care crisis plays out on screen. Each month the monitors show an average of 300 cardiac episodes, 200 traumatic injuries, 80 overdoses and 25 burns. There are patients suffering from heat stroke in South Texas and frostbite in Minnesota — sometimes on the same day. There are drowning deaths in summer, gunshot wounds during hunting season, car accidents on icy roads, and snakebites in spring.”
“Telemedicine [has] helped [rural] hospitals retain and recruit doctors because it gave them more support and allowed for more time off. It also allowed [these rural] hospitals to treat more patients on site rather than having to transfer them to bigger facilities, resulting in increased billing charges and more hospital income.”
This virtual hospital, at the other end, has “15 doctors and 30 emergency nurses who rotate through shifts . . . , and while all of them have trained for years inside regular ERs, nothing compared to the intensity of the industrial park. During one 24-hour shift, they often saw more critical cases on screen than most ER doctors encountered in a month: an average of one severe heart attack each shift, one suicide attempt, two pediatric emergencies, three traumatic injuries, four intubations, and five patients whose hearts had already stopped beating and needed immediate resuscitation.”
=====================================
[1] Saslow, The most remote emergency room: Life and death in rural America, Wash. Post (Nov. 16, 2019)
Remote Robotic Surgery Under Test by Mayo Clinic
Another mode of telemedicine might be remote robotic surgery, which will be tested this coming spring by the Mayo Clinic.
“That would be meaningful for patients in rural areas whose emergency cardiac procedures can be delayed [and less effective] . . . if their local hospitals aren’t equipped to provide a procedure known as a percutaneous coronary intervention, or PCI, said Dr. Mackram Eleid, the Mayo interventional cardiologist who is leading the remote research.”
Olson, Mayo will test robotic heart procedure for rural patients, StarTribune (Dec. 21, 2019), http://www.startribune.com/mayo-will-test-robotic-heart-procedure-for-rural-patients/566290072/
Closure of Another Rural Hospital Highlights Rural America’s Challenges
The Minneapolis’ StarTribune republished an editorial from the daily newspaper in Mankato, Minnesota that was triggered by the Mayo Clinic Health Systems recent announcement that early next year it would close a small-town hospital that had only nine inpatient admissions for the first 11 months of this year while its emergency department averaged fewer than four patients per day, thereby threatening its retention of accreditation.
“Dozens of rural hospitals have closed nationally this decade, mostly in the South, and as many as 430 more are said to be at risk of closing. We know, through scholarly studies, that mortality rates rise when a rural hospital closes and that childbirth complications rise when obstetric services are not locally available. Lose your hospital, and the quality of life declines.”
“And so we see the vicious circle at work. As rural America’s population declines, so does the quality of its health care — which helps prompt people to reside in urban areas with better health care. There is no obvious solution. But it is a genuine problem.”
Editorial, Rural health care: Vicious circle as population falls, servcies wane, StarTribune at OP2 (Dec. 22, 2019), http://www.startribune.com/rural-health-care-vicious-circle-as-population-falls-services-wane/566388892/