Monday Medical: Images tell the story for emergency care

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A young man injured in a car crash lies unconscious in Yampa Valley Medical Center's emergency department. A CAT scan has been done, and physicians are conferring about the patient's skull fracture.

Three doctors in separate locations in two cities are viewing and discussing the scan images simultaneously. The diagnostic radiologist and emergency medicine physician are at Yampa Valley Medical Center. The neurosurgeon is at Denver Health Medical Center.

After reviewing the diagnostic images on a computer, the neurosurgeon determines that the patient can be cared for in Steamboat Springs; a transfer to Denver is not necessary. The specialist recommends a course of care, including medication to prevent brain swelling.

Four months ago, this scenario might have ended very differently with an emergency flight to Denver. Today, the collaborative teleradiology system built by Denver Health enhances the quality of care for patients at YVMC and 11 other Colorado hospitals.

"We can work on these cases and help patients together," Denver Health Trauma Program Manager Debra Carpenter said. "The system allows us to be in partnership with referring hospitals. It's a huge plus for patient care."

YVMC emergency medicine physician and Chief of Staff Jeanne Fitzsimmons, M.D., agreed.

"When we have a more critically injured patient, we can consult with a Denver Health specialist to provide a quicker diagnosis and begin treatment faster," she said.

Carpenter said YVMC was one of the first hospitals to ask Denver Health what could be done to provide better patient service.

"We found a way to make it happen by communicating through radiologic technology," she said.

Vince Doyle, of Denver Health, was given the task of developing a software solution that would allow YVMC and other hospitals to transfer images electronically directly into Denver Health's enterprise digital imaging system. The imaging informatics manager and his team spent nine months creating a secure gateway.

The system went live in August. Doyle said it "gives our physicians eyes" to see what cannot be conveyed by a verbal conversation or written report.

YVMC is able to participate because it has digital imaging and archiving. Radiologic technologist Laura Corriveau is the administrator of YVMC's picture archiving computer system. She and the other techs in the radiology department send images when a consultation is requested.

When a patient transfer is necessary, the gateway solution can improve the care offered at both YVMC and the receiving hospital. The old practice of downloading diagnostic images onto computer discs to accompany transferred patients was not as effective.

"Sometimes it would take a long time to upload and view the files," Carpenter said. "Other times, our computers couldn't access the images.

"Now, when a transfer does occur, our specialists know in advance exactly what is coming in the door. Our doctors can look at the pictures and start gathering the team that will take care of that patient."

Physicians at YVMC and Denver Health can view radiology images from numerous computers at the hospitals, in their offices or even at home.

"This gives us 24-hour, immediate coverage by radiologists and other specialists," Fitzsimmons said. "Multiple physicians in different locations can view the same images simultaneously."

"It is helpful to get a colleague's perspective when there are more difficult cases," said J. D. Gilliland, M.D., one of three full-time radiologists at YVMC. "Consultation is immediately available."

For a trauma patient and emergency medicine physician, every tick of the clock counts. Technology and the partnership between YVMC and Denver Health have made it much easier to get an expert opinion and a rapid, accurate diagnosis.

"This system gives our patients who have more unusual cases access to Front Range physicians without having to go down there," Gilliland said. "They don't have to make a choice between here or there-in a big sense, here is there."

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