title: A statewide teleradiology system reduces radiation exposure and charges in transferred trauma patients.
abstract: BACKGROUND
  Trauma transfer patients routinely undergo repeat imaging because of inefficiencies within the radiology system. In 2009, the virtual private network (VPN) telemedicine system was adopted throughout Oregon allowing virtual image transfer between hospitals. The startup cost was a nominal $3,000 per hospital.
  
  
  METHODS
  A retrospective review from 2007 to 2012 included 400 randomly selected adult trauma transfer patients based on a power analysis (200 pre/200 post). The primary outcome evaluated was reduction in repeat computed tomography (CT) scans. Secondary outcomes included cost savings, emergency department (ED) length of stay (LOS), and spared radiation. All data were analyzed using Mann-Whitney U and chi-square tests. P less than .05 indicated significance. Spared radiation was calculated as a weighted average per body region, and savings was calculated using charges obtained from Oregon Health and Science University radiology current procedural terminology codes.
  
  
  RESULTS
  Four-hundred patients were included. Injury Severity Score, age, ED and overall LOS, mortality, trauma type, and gender were not statistically different between groups. The percentage of patients with repeat CT scans decreased after VPN implementation: CT abdomen (13.2% vs 2.8%, P < .01) and cervical spine (34.4% vs 18.2%, P < .01). Post-VPN, the total charges saved in 2012 for trauma transfer patients was $333,500, whereas the average radiation dose spared per person was 1.8 mSV. Length of stay in the ED for patients with Injury Severity Score less than 15 transferring to the ICU was decreased (P < .05).
  
  
  CONCLUSIONS
  Implementation of a statewide teleradiology network resulted in fewer total repeat CT scans, significant savings, decrease in radiation exposure, and decreased LOS in the ED for patients with less complex injuries. The potential for health care savings by widespread adoption of a VPN is significant.
authors.affiliation: Department of Surgery, Oregon Health and Science University, L611, 3181 SW Sam Jackson Park Road Portland, OR 97239, USA. Electronic address: watsonju@ohsu.edu.
authors.forename: Justin J J
authors.initials: JJ
authors.lastname: Watson
authors.affiliation: Department of Surgery, Oregon Health and Science University, L611, 3181 SW Sam Jackson Park Road Portland, OR 97239, USA.
authors.forename: Alexis
authors.initials: A
authors.lastname: Moren
authors.affiliation: Department of Surgery, Oregon Health and Science University, L611, 3181 SW Sam Jackson Park Road Portland, OR 97239, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Diggs
authors.affiliation: Department of Surgery, Oregon Health and Science University, L611, 3181 SW Sam Jackson Park Road Portland, OR 97239, USA.
authors.forename: Ben
authors.initials: B
authors.lastname: Houser
authors.affiliation: Department of Surgery, Oregon Health and Science University, L611, 3181 SW Sam Jackson Park Road Portland, OR 97239, USA.
authors.forename: Lynn
authors.initials: L
authors.lastname: Eastes
authors.affiliation: Department of Surgery, Oregon Health and Science University, L611, 3181 SW Sam Jackson Park Road Portland, OR 97239, USA.
authors.forename: Dawn
authors.initials: D
authors.lastname: Brand
authors.affiliation: Department of Surgery, Oregon Health and Science University, L611, 3181 SW Sam Jackson Park Road Portland, OR 97239, USA.
authors.forename: Pamela
authors.initials: P
authors.lastname: Bilyeu
authors.affiliation: Department of Surgery, Oregon Health and Science University, L611, 3181 SW Sam Jackson Park Road Portland, OR 97239, USA.
authors.forename: Martin
authors.initials: M
authors.lastname: Schreiber
authors.affiliation: Department of Surgery, Oregon Health and Science University, L611, 3181 SW Sam Jackson Park Road Portland, OR 97239, USA.
authors.forename: Laszlo
authors.initials: L
authors.lastname: Kiraly
mesh_terms: D000328:Adult; D017046:Cost Savings; D004636:Emergency Service, Hospital / Q000191:economics; D005260:Female; D006801:Humans; D008297:Male; D009922:Oregon; D010360:Patient Transfer; D000069079:Radiation Exposure / Q000517:prevention & control*; D012042:Registries; D012189:Retrospective Studies; D019112:Teleradiology / Q000191:economics* / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000191:economics / Q000706:statistics & numerical data; D014193:Trauma Centers / Q000458:organization & administration; D014947:Wounds and Injuries / Q000175:diagnosis* / Q000628:therapy
keywords: Charges; Decreased; Radiation; Reduction; Statewide; Teleradiology