Execute

The hardest and most dangerous part of TC is for the RE to efficiently provide an accurate consultation when unable to assess a casualty themselves – inaccurate information can lead to bad recommendations and, in the worst case, bad patient outcomes, or, more commonly, confusion. Consequently, the hardest part of TC for the LC is conveying an accurate description of a patient to a RE.

LCs must possess excellent assessment skills and the ability to convey their assessment to a RE efficiently. Inaccurate and/or incomplete assessments poorly communicated to a RE makes TC inefficient because the RE will inevitably pose probing questions of the LC to better understand a casualty’s condition, problems, and treatments.

To date, no adverse outcomes associated with military TC have been reported. More commonly, poorly communicated data or incomplete assessment leads to frustration, lengthy consultations, dissatisfaction with recommendations, and ultimately delayed casualty care.

To avoid this, LCs must be prepared for TC. Unfortunately, many caregivers may find conducting a TC to be anxiety provoking because they may be unsure of their assessment, uncertain about what information to provide an RE, and are worried the RE will judge them. Probing RE questions to gain further confidence in data shared may feel uncomfortable for LCs, especially if/when data is missing due to incomplete assessment. THIS IS COMMON: every caregiver has a different way of prioritizing information and not all information will be available at the time of consultation. Real world consultations take an average of three (3) synchronous TC encounters to complete, often with several asynchronous communications between synchronous touch points. Missing data may be filled in over-time and recommendations may be refined or even changed as information is updated.

The following best practice recommendations have been identified to maximize TC efficiency, information transfer, and quality of recommendations while minimizing frustration and risk of missing information necessary for best consultation in context:

1. If calling the ADVISOR line:

- When the agent answers the phone, tell the agent if the call is real-world and deployed or in garrison or for training.
- Indicate the specialty needed or, if unknown, ask for the emergency department.
- Provide a good call-back number.

2. Use a script familiar to the both the local caregiver and remote consultant (see Appendix B for an example with an instruction on use).

3. Send background information using asynchronous technology ahead of synchronous TC encounters (see below).

4. Use closed loop communication that includes intentional pauses in communication for read-back and clarification.

5. Have the RE document the telemedicine encounter and send that documentation with a summary of recommendations to the LC using an agreed upon asynchronous solution.