Tags: technology , redesigning care

Since 2013 Newton-Wellesley Hospital has been host to the National TeleNursing Center (NTC), an ambitious project funded by the federal government to develop a trauma-informed and culturally responsive model for providing telenursing services to survivors of sexual assault in remote communities.

Powered by an expansive partnership between several state, federal, and non-governmental agencies—including the Massachusetts Department of Public Health (MDPH)—the NTC today operates in 6 pilot states, 24 hours a day, 7 days a week.

For NTC co-directors Joan Meunier-Sham and Cheryl Re, and NTC Administrator Amanda Wyma, the growth unquestionably demonstrates a dramatic improvement in the way trauma-informed care can serve remote or under-resourced facilities and communities.

“When we started this process, we honestly didn’t know how it would be received,” Ms. Wyma said. “There was skepticism, especially because the cases involved such intense trauma, but we’ve actually seen the total opposite, where patients have openly accepted the service.”

At the core of the NTC is a skilled team of telenursing specialists selected from the MDPH Sexual Assault Nurse Examiner Program (SANE). These specialists, called TeleSANEs, utilize telemedicine equipment to provide remote guidance and support to facilities in tribal lands, military bases, a remote access Hospital, as well as in two Ma. Hospitals.

As of July 1st, 2016 the National TeleNursing Center is live with 6 pilot sites, and provides 24/7, 365 day support and guidance to patients and clinicians in these settings.

“In each of the remote sites, we have clinicians who are often trained as sexual assault examiners, but don’t see many patients. Even with training, the clinicians’ comfort level was low,” Re said. “And, obviously, there is a lot of anxiety when you’re caring for a sexual assault patient. Clinicians know that some cases will proceed to a criminal prosecution and the clinician may need to testify”.

With NTC, clinicians have a TeleSANE virtually at their side to jump in and make suggestions about evidence collection documentation, or general support of their practice. “Physicians, nurses and nurse practitioners have reported feeling more confident going into sexual assault cases as a result of this partnership,” Re said.

The NTC process works like this: A patient enters a hospital at a remote site, and would disclose a sexual assault to the staff. They would then accept or decline the option of forensic evidence collection. They would also need to consent to or decline NTC’s services.  If they agree to a NTC encounter, a TeleSANE specialist is present, via webcam, for the full duration of the exam. In all cases, the program remains patient centered, Wyma said, and the examination can switch to audi0-only at any point to ensure the maximum comfort of all patients. 

“We’ll be there for the entire examination—the entire 2 to 6 hours,” Re said. “We're interacting with the patient, the nurse, and everyone else who may be in the room.”

NTC’s ultimate goal is to provide trauma-informed care to sexual assault patients; to improve clinical and forensic evidence collection practices; to enhance rape crisis advocacy responses; and to provide opportunities for peer support and debriefing for remote site clinicians and TeleSANEs.

Outside the exam room, the NTC is having an impact too.

“We are absolutely seeing a comfort level increase with medical staff as they realize they have a specialist working with them, but that mentality has also expanded to the broader community. We are seeing police and rape crisis advocates referring patients to receive care at our remote sites, knowing that the NTC is supporting their local clinicians to provide the best care possible,” Meunier-Sham said.

Another discovery is the low number of patients who have declined the services of the NTC: Of the 71 possible encounters since June 2016, only 6 patients have declined to participate in NTC services. Several patients who did participate, noted that they were grateful that the care they needed was considered important enough that a sexual assault expert was brought in to consult and advise the medical staff on site, even if done remotely.

“Through it all we’ve been incredibly grateful to NWH and Partners HealthCare,” Meunier-Sham said. “This program could not have seen the success that it has without their support. It goes without saying, but it’s true.”