Patients could someday benefit from Case Western Reserve University nursing study
The increased use of medical helicopters over the last half-century has saved countless lives by quickly getting patients from trauma to the emergency room (ER) within the so-called “golden hour.”
But a growing number of medical experts contend emergency helicopters may be overused in some transfer situations. Their concern: patients stuck with an exorbitant cost for a service that may not have been necessary and isn’t fully covered by their insurance.
Now, a researcher
at the Frances Payne Bolton School of Nursing at Case Western Reserve University
is leading a study he believes will support what he says is a much-needed change
in how medical helicopters are used—especially for transfers between hospitals.
emergencies, it is quicker and better to transport someone by air, but that’s
not the majority of the transfers being made,” said researcher Andrew Reimer, an assistant professor and longtime
flight nurse who has made hundreds of emergency flights before and during his nursing career at Case Western Reserve.
ability to quickly move patients by medical helicopter is especially vital in what
is known as the golden hour—that first hour after a traumatic injury,
considered the most critical for successful emergency treatment.
“I have moved a
lot of people who didn’t necessarily benefit from moving, and many of us had
felt it was too automatic to just make the helicopter transfer, but we didn’t
have the numbers to back it up,” he said. “Now we do, so it’s time to
re-imagine the way we do non-time-sensitive transports.”
Most comprehensive study yet
Reimer said most previous studies of the issue were “confounded by not having pre-transfer data about the patients.” An electronic medical record (EMR) dataset, developed by Reimer with Damon Kralovic, medical director of Critical Care Transport at Cleveland Clinic, however, helped him advance existing research by having detailed medical conditions of thousands of patients before, during and after being transferred by helicopter from one hospital to another.
Reimer and his
nursing and computer science students are feeding that information into a
computer algorithm they had built to identify which patients actually need the
speed of a helicopter transfer—and which could either stay put or be
transferred by ambulance.
They hope to turn
that information into a computer-generated checklist to determine which
patients will benefit from an air transfer. Using data such as age,
pre-existing illnesses and key vital signs would place patients in categories
about their “very specific risk of mortality, based on every possible
combination in the data,” he said.
Eventually, Reimer said, this information could be included in each patient’s EMR to provide guidance on whether he or she would benefit from an air transfer.
“There are obvious
cases on both ends, but this guide helps us decide on a whole group of patients
who are sort of in the middle,” he said. “This data can help us know ahead of
time who will benefit—and who won’t.”
“Let’s face it: For many, many patients, a $5,000 ambulance trip is better than a $50,000 helicopter ride,” he said. “So, if we can make better, data-driven decisions about who should be transferred by air and when, it will save money—and save the helicopter resource for when it is needed most.”