Wiktor Arek J, Madsen Laura, Carmichael Heather, Smith Tyler, Zanyk Shana, Amani Hamed, Wagner Anne Lambert
Department of Surgery, University of Colorado School of Medicine, Aurora.
Burn Unit, University of Colorado Hospital, Aurora.
J Burn Care Res. 2018 Oct 23;39(6):858-862. doi: 10.1093/jbcr/iry041.
Technology and telehealth have the potential to optimize burn care in areas limited by lack of expertise and geographic distance from a Burn Center. This study reports a multicenter, multiregional experience using a mobile phone app to facilitate triage of patients by allowing referring providers to send encrypted photos, thus enhancing the telephone consultation process. A retrospective review was conducted on referrals from August 2016 to July 2017 at three regional Burn Centers that utilize the same mobile phone app. Centers studied are located in the Western, Northeastern, and Southern regions of the United States. Data on numbers of admissions, consults, referral facilities, type of wounds, disposition, and distance from the Burn Centers were recorded. A total of 2011 consults were placed using the mobile phone app from 294 different referring facilities spanning seven states. Utilization of the mobile phone app ranged from 20.4% to 84% among centers. All three centers demonstrated a similar range of consult distances (0-289 miles). Overall, the top three referral diagnoses were scald, contact, and flame burns. Regional differences included a higher percentage of frostbite in the Western region (P < 0.001) and a higher percentage of scald burns in the Northeastern and Southern regions (P < 0.001). The majority of patients at all centers were referred to outpatient clinics for ongoing burn care. Utilization of a mobile phone app appears to be a useful tool in the triage of patients, but further studies are warranted to assess the impact on accuracy of triage, patient outcomes, and reduction of costs.
在因缺乏专业知识以及与烧伤中心存在地理距离而受限的地区,技术和远程医疗有潜力优化烧伤护理。本研究报告了一项多中心、多地区的经验,即使用一款手机应用程序,通过允许转诊提供者发送加密照片来促进患者分诊,从而改进电话咨询流程。对2016年8月至2017年7月期间在三个使用同一手机应用程序的地区烧伤中心的转诊情况进行了回顾性研究。所研究的中心位于美国西部、东北部和南部地区。记录了入院人数、咨询次数、转诊机构、伤口类型、处置方式以及与烧伤中心的距离等数据。共有来自七个州的294个不同转诊机构使用该手机应用程序进行了2011次咨询。各中心对该手机应用程序的使用率在20.4%至84%之间。所有三个中心的咨询距离范围相似(0 - 289英里)。总体而言,前三大转诊诊断为烫伤、接触性烧伤和火焰烧伤。地区差异包括西部地区冻伤的比例较高(P < 0.001),以及东北部和南部地区烫伤的比例较高(P < 0.001)。所有中心的大多数患者被转诊至门诊进行持续的烧伤护理。使用手机应用程序似乎是患者分诊中的一个有用工具,但需要进一步研究以评估其对分诊准确性、患者结局和成本降低的影响。