Fletcher Allen, a Vermont university hospital and medical center, serves all of
Vermont and the northern New York region. Located in Burlington, Fletcher Allen is a regional, academic healthcare center and teaching hospital in alliance with the University of Vermont.
Clinical Services Provided via Telemedicine
Telemedicine provides high-quality patient care to even the most rural of communities. It allows the patient to remain within their community and be seen by specialists, eliminating the expense and need for time-consuming travel for patients and/or specialists. (This is especially relevant for VT and upstate NY with their harsh winter climate and mountainous terrain.)
A care plan can be developed with the patient, their local provider, and the remote specialist together, or the need for transfer to Fletcher Allen can be determined. Should transfer be decided, the patient has already met with the doctor who will provide the care here at Fletcher Allen. Many clinical specialties at Fletcher Allen have the capability to use telemedicine for their consultations, but these areas below have been the busiest of late.
Telemental health services are utilized more than any other clinical telehealth application in the United States. Fletcher Allen developed one of the first telepsychiatry consultation programs for skilled nursing facility residents in the country and continues to provide care for this underserved population through videoconference. Through live teleconsultations with a Fletcher Allen psychiatrist, elderly patients receive psychiatric examinations, recommendations, and follow-up care, allowing these frail seniors the opportunity to receive psychiatric services that would otherwise be unavailable.
Often family members and local nursing and social services staff participate in these consultations. The results of the first eight years of this program are reported here: Rabinowitz T, Murphy KM, Amour JL, Ricci MA, Caputo MP, Newhouse PA. Benefits of a telepsychiatry consultation service for rural nursing home residents. Telemed J E Health 2010; 16:34-40.
In addition to clinical services, the telemental health program is actively involved in research. A study to examine the feasibility of providing mental health care to homebound depressed elders was recently completed and a study to examine the efficacy of post-traumatic stress disorder (PTSD) treatment of veterans of Operation Iraqi Freedom and Operation Enduring Freedom began in 2010.
Pediatric Emergency Medicine
Fletcher Allen is committed to being a national model for the delivery of high-quality academic health care for a rural region. Doctors at Vermont Children’s Hospital at Fletcher Allen recognized a disparity in access to pediatric health care between rural and urban areas. While one in five children live in rural areas, only 3% of specialists in pediatric intensive care practice in rural areas. Serious illness or injuries are rare events in childhood but they have the potential to cause great harm. Most rural hospitals do not have immediate access to pediatric emergency specialists.
At Vermont Children’s Hospital, Pediatric Critical Care specialists in the Pediatric Intensive Care Unit realized that they were often hours away from providing care to these critically ill patients. For these reasons, in March 2006 Fletcher Allen introduced an innovative program in rural pediatric emergency telemedicine.
Pediatric intensivists provide coverage for emergency consultations in emergency departments in eleven rural community hospitals in Vermont and upstate New York. The program has been very successful and was recently reported as the first and largest rural pediatric emergency telemedicine program in the United States (Pediatric Critical Care Medicine 2009;10:588 and Pediatric Critical Care Medicine 2009;10:606).
The Fletcher Allen Palliative Care Telemedicine Consult project was begun to provide additional support to our referring hospitals when transferring a patient to our Medical Intensive Care Unit (MICU). When a patient, who may not survive their hospital stay, is referred to our MICU, a telemedicine conference can be conducted between the patient or family and referring physician located at the referring site, and the Fletcher Allen MICU attending and palliative care physician prior to the transfer.
The goal of this program is to improve communication and quality of care for patients being transferred to the MICU. Palliative care programs are primarily available only in tertiary care settings; our telemedicine program makes it possible for us to provide this expertise to community hospitals in the region.
Since 1996 the Department of Surgery has offered various services through the telemedicine system. Most frequently, wound care has been delivered by vascular surgeons. Patients with chronic wounds and diabetic foot ulcers, both pre and post-operatively, living at a distance from Burlington, have avoided the time and cost of travel here by having follow-up visits performed by our specialists over the telemedicine system to the patient’s local hospital.
Surgical services also use telemedicine to demonstrate live surgical laparoscopic procedures from Fletcher Allen’s or to high school students (AHEC MedQuest Health Careers Exploration Program) and to medical students observing from another location.
Emergency Trauma Care
Studies indicate that rural trauma patients die twice as often as those in urban areas. Time, distance and training are the primary culprits. Longer discovery times after injury, greater distances to travel to get to treatment and the lack of available specialists trained and experienced in acute trauma care all contribute to increased, possibly unnecessary deaths.
Fletcher Allen physicians provide real time, high-quality trauma care to rural hospitals in VT and upstate NY and can use telemedicine when they believe it will further benefit the patient at hand. When an emergency department doctor at a remote hospital places an 800 number call to Fletcher Allen's Provider Access Service (PAS), the PAS operator then contacts the on-call trauma physician.
When the on-call physician thinks it would be beneficial, he/she can utilize the nearest telemedicine workstation in the hospital to dial into the remote emergency department and do a video teleconsult, rather than a phone consult.
Some of the trauma physicians believe their virtual presence in the remote hospital Emergency Department has at times helped save a life or avoided long transports of a patient to the Fletcher Allen Trauma Center.