Researchers at UC Davis and other facilities have shown that telehealth consultations for clinicians at rural hospitals improve their ability to provide forensic examinations for sexual abuse. Published in the journal Child Abuse & Neglect, the study showed that clinicians with access to expert UC Davis nurses provided more thorough and nuanced exams, improving their ability to gather evidence and to make an accurate diagnosis.
"Providing telehealth support really improves the quality of these forensic exams," said first author Sheridan Miyamoto, a forensic nurse practitioner and research nurse at the Betty Irene Moore School of Nursing at UC Davis. Miyamoto is also a 2014 doctoral graduate of the Betty Irene Moore School of Nursing. "With this technology, we can help children who might otherwise not receive this level of care."
Provided by advanced practice nurse practitioners and sexual assault nurse examiners with more than 10 years of experience evaluating abuse, telehealth consults offer tremendous benefits for rural communities. In addition to improving quality, they ease the burden on families, who no longer need to travel many hours for expert care, and clinicians, who have access to trained mentors when conducting these delicate exams. As a result, these consults provide a safety net for clinicians, patients and parents, ensuring these procedures are both thorough and accurate.
"It's important that we get this right," said Miyamoto. "Due to a lack of experience and regular exposure, many examiners are prone to assess normal variations as injuries from trauma. On the other hand, we also want to protect the child. Strong evidence may result in a plea bargain, eliminating the added stress for children of having to testify in court. Telehealth offers support and built-in peer review for nurses, physicians and other clinicians practicing in relative isolation."
The telehealth network uses secure teleconferencing equipment to link UC Davis nurses with rural clinicians. The systems provide video and audio, as well as images from colposcopes (magnifying devices used to examine genitalia) and other equipment. This advanced technology essentially puts expert nurses in the room with examining clinicians.
To test whether telehealth improved care, the researchers brought in independent experts to review examinations from eight rural hospitals, five of which had access to telehealth consults. The experts reviewed the health records for 183 patients, 101 of whom were treated at telehealth hospitals, evaluating the thoroughness, accuracy and overall quality of these exams.
The telehealth exams improved care in multiple areas, including examination findings, overall assessments, completeness and diagnostic accuracy. In addition, photo and video quality was dramatically improved, evidence that could enhance court proceedings. Overall quality, completeness and accuracy scores were all significantly higher in the telehealth hospitals.
The UC Davis team hopes these findings will spur other hospitals to expand their telehealth capabilities.
"If we create a statewide network, we can really improve the quality of these exams in rural communities," said Miyamoto. "We can provide a service for many children who don't receive this level of care and make sure issues that should be investigated are investigated."
- Sheridan Miyamoto, Madan Dharmar, Cathy Boyle, Nikki H. Yang, Kristen MacLeod, Kristen Rogers, Thomas Nesbitt, James P. Marcin. Impact of telemedicine on the quality of forensic sexual abuse examinations in rural communities. Child Abuse & Neglect, 2014; DOI: 10.1016/j.chiabu.2014.04.015
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