Rural Medical Center Research Articles

Improving Patient Experience and Team Engagement with Environmental Services: Application of Watson's Theory of Human Caring.

Patient experience and team engagement are key performance indicators in organizational strategic planning. Health-care organizations have a seldom-used resource within acute care settings that expands the ability to improve patients' experiences of their care as well as their own team engagement. Environmental services (ES) staff, the second largest health-care workforce, spend an average of 10 min per patient day interacting with patients and families. Few studies highlight how nursing theory may influence patient experience outside of the nursing role. This paper explores how ES staff at a non-profit rural 974-bed academic medical center impacted patient experience using nursing theory to promote a caring environment. Applying Watson's Theory of Human Caring and Caritas Processes© with ES team members beginning at leadership levels increased team engagement and improved patient experience. ES team members benefited from a professional nursing framework and from being integrated as a valued partner in advancing human caring.

Exploring the Impacts of Artificial Intelligence Interventions on Provider Practice practice

Abstract Background Despite the growing prevalence of AI in healthcare, there has been a lack of recent studies exploring its impact on providers’ practices and patient outcomes. This study investigates healthcare providers’ perceptions of AI interventions’ influence on their practice efficiency and patient outcomes, as well as the correlation between providers’ perceptions of AI and its effects on patient outcomes. Methods A self-administered questionnaire was mailed to 38 healthcare providers at a rural medical center in north Texas, with a 70% percent response rate (n = 27). In addition to descriptive statistics, multivariable logistic regression test was conducted to discern the relationship between their perceptions of AI and its impact on patient outcomes. Results The findings revealed that a majority of providers perceived AI to still be in its early stages, posing challenges for practice and having a limited impact on patient outcomes. Additionally, various factors such as age, gender, a user-centered design approach, AI experience, along with perceptions of workplace support and stress, significantly shape providers’ attitudes toward AI and ultimately affecting patient outcomes. Conclusions Before AI technology can fulfill its promise of transforming healthcare through integration with other technologies, the healthcare sector must address numerous hurdles. It is crucial to approach the development and testing of intricate systems like AI-integrated electronic health record (EHR) systems with caution to ensure their reliability and dependability in clinical decision-making. Additionally, navigating medico-legal responsibilities and pursuing fair distribution of benefits are equally crucial. Key messages • This study offers insights into the extent of AI interventions’ impact on healthcare. • This study specifically focuses on enhancing patient care, reducing costs, and improving the efficiency of the healthcare system.

S467 A Retrospective Study Examining the Impact of Computer-Aided Detection on Adenoma Detection Rate Amongst Non-Gastroenterology Endoscopists in a Rural Medical Center

S467 A Retrospective Study Examining the Impact of Computer-Aided Detection on Adenoma Detection Rate Amongst Non-Gastroenterology Endoscopists in a Rural Medical Center

A comparative study between first three waves of COVID-19 pandemic with respect to risk factors, initial clinic-demographic profile, severity and outcome

ABSTRACT Introduction: During the 2 years and 9 months from March 2020 to December 2022, the SARS-CoV-2 virus raged across the country. Cases occurred in three particular time clusters recognised by World Health Organisation as coronavirus disease 2019 (COVID-19) waves. In this study, we compare the clinical parameters of adult non-obstetric COVID-19 patients admitted to our rural tertiary care hospital during the three distinct waves of the pandemic. Materials and Methods: Retrospective chart analysis of 272, 853 and 97 patients admitted with SARS-CoV-2 infection to the only rural medical tertiary care centre in the Sunderbans of West Bengal in the first, second and third waves, respectively, was done after obtaining ethical and scientific clearance. Clinical [vital parameters, oxygen requirement, mental status, risk factor assessment, duration of hospital stay, modified-emergency warning score (m-EWS), quick Sequential Organ Failure Assessment (qSOFA), confusion, uraemia, respiratory rate, blood pressure, age ≥ 65 years (CURB65)], epidemiological variables (age, gender, and vaccination status), laboratory parameters and in-hospital outcome were recorded and analysed statistically. Results: Statistically significant (P < 0.05) m-EWS and qSOFA scores were recorded during the second wave of the pandemic. The second wave also recorded the highest mortality (14.89%) compared to the first (12.87%) and third (11.96%) waves, though this was not statistically significant. The highest duration of hospital stay was recorded in the first wave of the pandemic (mean = 9.99 days, P < 0.01). The difference in mortality rates between patients with and without co-morbidity (P < 0.05) was observed during Wave-1, across any pandemic wave, and overall but not in Wave-2 and Wave-3. Conclusion: The second wave of the COVID-19 pandemic was the most severe in comparison with the other two waves, while the outcome was poorer in those with co-morbidities, especially in the first wave.

Clinical Features and Outcomes of Patients with Idiopathic Inflammatory Myositis-Associated Interstitial Lung Disease in Rural Appalachia: A Cross-Sectional Study.

Idiopathic inflammatory myopathies (IIMs) are a group of autoimmune disorders often complicated by interstitial lung disease (ILD). The clinical characteristics and outcomes of IIM-associated ILD have been reported variably, but the literature on rural populations is scarce. A retrospective cross-sectional study was conducted at a rural tertiary academic medical center. Twenty-nine patients met the final inclusion criteria. The primary outcome was to assess the disease state and immunological and radiographic features of IIM-associated ILD. Secondary outcomes included disease progression, ILD exacerbation, mortality rate, and factors associated with poor outcome. Dermatomyositis (n = 15, 51.72%) followed by polymyositis (n = 8, 27.58%) were predominant myopathies. The most common autoantibodies were anti-Jo1 antibodies (n = 11, 37.93%). Indeterminate usual interstitial pneumonitis (41.30%, n = 12) was the most common radiographic pattern followed by non-specific interstitial pneumonia (n = 5, 17.24%). ILD exacerbation (n = 14, 66.66%) and mortality rate (n = 6, 20.69%) were high. Albumin levels were significantly lower in patients who died. The clinical characteristics of patients with IIM-associated ILD in rural Appalachia exhibit notable distinctions, and outcomes are worse compared to other populations. Larger studies are needed to investigate other prognostics factors and longitudinal trends of clinical characteristics and outcomes of IIM-associated ILD in rural populations.

Facility-based approach for the management of acute ST segment elevation myocardial infarction with cardiogenic shock in a rural medical centre: the Durango model

IntroductionCardiogenic shock (CS) complicates 5%–15% of cases of acute myocardial infarction (AMI) with inpatient mortality greater than 40%. The implementation of standardised protocols may improve clinical outcomes in patients with...

Developing a rural Veterans Affairs health care research program: Diligence and unique resolutions

LAY SUMMARY Development and growth of a rural Veterans Affairs Medical Center (VAMC) research program is one way to provide best care. This article reports the steps and barriers to building a rural research centre, using examples from western North Carolina. One goal driving the research centre’s creation was to increase under-served communities in the research workforce and among participants enrolled in Veterans Health Administration (VHA) research. The VHA reports health care differences for 4.7 million rural and highly rural Veterans, with rural Veterans using VHA services differently than urban and suburban Veterans. A total of 58% of rural Veterans enroll in the VHA, compared with 37% of urban and suburban Veterans. To achieve optimal Veteran health, all Veteran sub-groups must be adequately represented in clinical research trials, but rural Veterans are currently not equally represented. Research centre development steps included: 1) hiring a program specialist to focus on developmental needs, 2) finding a local program assistant to address the details required to develop a research centre, 3) obtaining a designated regulatory staff member, 4) negotiating staff, space, and focus needs, 5) hiring an experienced researcher to support initial research efforts, and 6) networking with other VAMCs, hospitals, agencies, and universities to create a best-care community.

Short-term medical student placements completed consecutively at a rural general practice positively impact chronic disease management

Little is known about how medical school placements in rural areas impact key stakeholders such as patients, host organisations and the wider rural community. With engagement from rural communities crucial to the success of rural medical training, this case study sought to demonstrate the benefit that rural clinical placements can have on rural general practices (systems) and likely impacts on communities (health outcomes). Specifically, we describe how a series of consecutive short-term student placements in a single rural practice were the drivers of a series of clinical audits and interventions resulting in improved management of chronic disease. Data for this project were obtained from student research reports completed as part of a rural and remote medicine rotation at an Australian medical school. For this series of projects, eight consecutive students were based at the same rural medical centre, with each attending for 6 weeks across a 15-month period, completing a report for a quality improvement activity and evaluating the outcomes. Each project related to chronic kidney disease (CKD), with CKD chosen based on the needs of the medical centre and the higher burden of this disease in rural areas. Each project was developed and delivered in consultation with the practice, taking into account student interest and skills, and related projects completed prior or concurrently. Projects were related to database management (n=2), alignment between CKD management and best-practice guidelines (n=3), patient health literacy (n=3), and a summary and staff perceptions of the preceding quality improvement activities (n=1). The combination of student projects led to tangible improvements in CKD management at a rural general practice. All doctors at the medical centre (n=4) reported using the database management tools implemented by the students and felt the interventions were sustainable, long-term solutions for ensuring clinical investigations are not being delayed or missed. Following the various interventions completed by the students, clinician knowledge and implementation of best-practice CKD management increased, and some patients became more aware of their condition and how to manage it. This case study provides evidence that short-term rural clinical placements for medical students have the potential to greatly improve health care and clinical practice in rural and remote communities, when designed around a consistent topic within a medical practice. Outcomes of the student projects in combination demonstrate that addressing CKD management longitudinally led to improvements in administrative processes, clinical practices, and patient awareness and accountability, despite each student only being at the medical centre for a short period of time. Similar approaches to structuring rural clinical placements and defining community projects for medical students should be considered more broadly.

Provider Satisfaction With Artificial Intelligence–Based Hand Hygiene Monitoring System During the COVID-19 Pandemic: Study of a Rural Medical Center

ObjectiveThe objectives of this study were to investigate providers’ attitudes toward an artificial intelligence (AI)–based hand hygiene monitoring system and to examine the relationship between provider well-being and satisfaction with the usage of that system. MethodsA self-administered questionnaire was mailed to 48 health care providers (ie, physicians, registered nurses, and other providers) at a rural medical center in north Texas between September and October 2022. In addition to descriptive statistics, Spearman's correlation test was conducted to discern the relationship between provider satisfaction with the usage of the AI-based hygiene monitoring system and their well-being. A Kendall's tau correlation coefficient test was utilized to assess the correlation between subgroup demographics and survey questions. ResultsWith a 75% response rate (n = 36), the providers reported sufficient satisfaction with monitoring system usage and that AI directly affects provider well-being. Providers with more years of experience and younger than 40 years of age reported significantly higher satisfaction with AI technology in general and considered the amount of time that they spent on AI-related tasks as interesting compared with their counterpart providers. ConclusionThe findings suggest that higher satisfaction with the AI-based hygiene monitoring system was related to greater provider well-being. Providers sought successful implementation of an AI-based tool that met their expectations, but such implementation required marked levels of consolidation to ensure that it fits within the existing workflows and was accepted by users.

Frugal digitization of analog video endoscopic medical records in a Kenyan rural medical center

Background: Digitization of healthcare data has led to widespread healthcare transformation. This has been enhanced by the availability of new technologies at lower costs. Video recording can improve the quality of care, provider skills, education, and patient follow-up. However, limitations such as the risk of litigation, patient privacy, and poor legal framework have curtailed adoption. Rural hospitals have older analog equipment due to limited financial resources. Objectives: This study aims to present an alternative low-cost option. Methods: We present an economical method of recording and digitizing endoscopic and laparoscopic procedures performed on analog video processing towers. We showcase a video of the step-by-step procedure that involves connecting a digital video home system (VHS) video recorder to an analog Olympus endoscopy machine (Model CV-100) and transferring media via a portable storage device to an electronic medical record database. Conclusion: Using simple home video recording devices provides a low-cost solution to creating digital records from analog video endoscopic machines. The technique, however, creates additional steps to the endoscopy process and the need for capacity building of the endoscopist. Patient consent forms should cover video creation. Medical centers should have a robust information management system to securely store and retrieve digitized video records.

Real-Time, Automated, Multiobjective, Cloud Computing Whole Slide Imaging Device

We present a novel approach to Whole slide imaging that consists of a uniquely designed, Low-cost, single-unit-portable, optically isolated-dust free, onboard mini-computer integrated, fully enclosed Whole Slide Imaging scanner device that can be wirelessly controlled through an easy-to-use, intuitive user interface-application on an iPad. A LabVIEW-based control software interfaces with multiple hardware modules within the device using the Queued Message Handler (QMH) architecture optimized to handle synchronous and parallel real-time processes. The system scans an area of 15×15 mm <sup xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">2</sup> in ~5 minutes at a resolution of ~0.25μm with a 40x Objective Lens. With a low weight of 12kg, the enclosure dimensions being 340 × 265 × 300 mm, and its low cost of building the device makes it more portable and affordable to the intended rural and low-tier medical centers. The instrument incorporates features such as automatic slide loading, slide registration, Brightness control, Slide scanning, and an Autofocus algorithm implementing a unique “convolution-histogram mean value” method to determine the Z-focus map. The work showcases a shift in pre-processing computations to the cloud server and integrating AI/ML tools for advanced database and image processing techniques on a portable device. A non-medical application of studying plasma science using the instrument has also been presented, demonstrating its wider application in medical and non-medical fields.

Utilization Trends of Intraoperative Neuromonitoring for Anterior Cervical Discectomy and Fusion in New York State.

Retrospective cohort analysis. To elucidate trends in the utilization of intraoperative neuromonitoring (IONM) during anterior cervical discectomy and fusion (ACDF) procedures in NY state using the Statewide Planning and Research Cooperative System and to determine if utilization of IONM resulted in a reduction in postoperative neurological deficits. IONM has been available to spinal surgeons for several decades. It has become increasingly prevalent in all facets of spinal surgery including elective ACDF procedures. The utility of IONM for preventing a neurological deficit in elective spine procedures has recently been called into question. The Statewide Planning and Research Cooperative System database were accessed to perform a retrospective cohort study comparing monitored versus unmonitored ACDF procedures between 2007 and 2018 as defined by the International Classification of Disease-9 and 10 Procedural Coding System (ICD-9 PCS, ICD-10 PCS) codes. Patient demographics, medical history, surgical intervention, pertinent in-hospital events, and urban versus rural medical centers (as defined by the United States Office of Management and Budget) were recorded. Propensity-score-matched comparisons were used to identify factors related to the utilization of IONM and risk factors for neurological deficits after elective ACDF. A total of 70,838 [15,092 monitored (21.3%) and 55,746 (78.7%) unmonitored] patients' data were extracted. The utilization of IONM since 2007 has increased in a linear manner from 0.9% of cases in 2007 to 36.7% by 2018. Overall, baseline characteristics of patients who were monitored during cases differed significantly from unmonitored patients in age, race/ethnicity, insurance type, presence of myelopathy or radiculopathy, and Charlson Comorbidity Index; however, only race/ethnicity was statistically significant when analyzed using propensity-score-matched. When comparing urban and rural medical centers, there is a significant lag in the adoption of the technology with no monitored cases in rural centers until 2012 with significant fluctuations in utilization compared with steadily increasing utilization among urban centers. From 2017 to 2018, reporting of neurological deficits after surgery resembled literature-established norms. Pooled analysis of these years revealed that the incidence of neurological complications occurred more frequently in monitored cases than in unmonitored (3.0% vs. 1.4%, P < 0.001). The utility of IONM for elective ACDF remains uncertain; however, it continues to gain popularity for routine cases. For medical centers that lack similar resources to centers in more densely populated regions of NY state, reliable access to this technology is not a certainty. In our analysis of intraoperative neurological complications, it seems that IONM is not protective against neurological injury.

1658. Using remote Infectious Disease physician expertise to support inpatient antibiotic stewardship activities at three VA medical centers an implementation-effectiveness trial

Abstract Background Remote Infectious Disease (ID) physicians can provide stewardship support through telehealth. Using the RE-AIM framework, we assessed the implementation of telehealth-supported prospective-audit-and-feedback (tele-PAF) across 3 rural Veterans Administration medical centers (VAMC). Methods All 3 invited sites agreed to participate and lacked ID support for stewardship at baseline. During 2021, an ID physician met virtually 3 times/week with the stewardship pharmacist champion at each participating VAMC to review patients on antibiotics in acute-care (mean daily census 3/site) and nursing-homes (NHs; mean census 71/site); real-time feedback on antibiotic use was given to clinicians. The primary outcome of effectiveness was monthly antibiotic days of therapy (DOT) per 1,000 days-present aggregated across all sites; the secondary outcome was days of antibiotic spectrum coverage (DASC) per 1,000 days-present. An interrupted time-series analysis was performed to asses these outcomes during the 1-year intervention period vs. the 2-year prior baseline. Semi-structured interviews with 20 clinicians and pharmacists were conducted to assess implementation. Results RE-AIM elements are summarized in Table 1. Tele-PAF reviewed 502 unique patients and made 681 recommendations to 23 clinicians; 77% of recommendations were accepted. The most common recommendations were to stop antibiotics (28%) and change duration (20%). After the start of tele-PAF, antibiotic DOT and DASC immediately decreased in acute-care (-20%, p=0.01; -22%, p&amp;lt; 0.01) and NHs (-28%, p=0.03; -37%, p&amp;lt; 0.01). Both metrics began to rise again in acute-care (DOT: +2.5%/month, p=0.02; DASC: +2.7%/month, p=0.02) but were stable in NHs (Figure 1). Clinicians generally appreciated feedback, found it compatible with their workflow and responded favorably to collaborative discussions. Barriers included difficulty establishing rapport with some providers. Conclusion The implementation of tele-PAF was associated with sustained reductions in antibiotic use across 3 NHs but not in the studied small acute-care units. Overall, clinicians perceived the intervention as acceptable and appropriate. Wider implementation of telehealth-supported stewardship activities may achieve reductions in antibiotic use. Disclosures Daniel J. Livorsi, MD, Merck &amp; Co.: Grant/Research Support.

Providers’ Experience with Artificial Intelligence-Based System During the COVID-19 Pandemic

Abstract Background As the pandemic continues to spread worldwide, many of healthcare facilities are exploring new methods to keep their patients safe from potential hospital-acquired infections (HAIs) during the pandemic. This study explored the attitudes about artificial intelligence (AI) among providers who utilized AI-based hand hygiene monitoring system (HHMS) at a rural medical center during the pandemic. Methods A self-administered questionnaire was mailed to 48 healthcare providers at a rural medical center in north Texas, with a 75% percent response rate (n = 36). The survey collected information on providers attitudes about AI-based HHMS use. In addition, the study also examined the relationship between provider’s well-being and the level of satisfaction with the AI-based HHMS use. The lessons learned from this study will be used to determine important factors to consider when attempting to advance and expand AI technologies in rural healthcare settings. Results Results revealed that the integration of AI technology within the existing electronic health record (EHR) system remains a challenge for many providers. Plus, the lack of user-centered design approaches to incorporate the AI tool into existing workflows has reduced providers satisfaction about the new technology. Conclusions The findings suggested that although AI technology has great promise to reduce the number of hospital-acquired infections (HAIs), successfully implement of an AI-based tool that meets the expectations of users requires significant levels of consolidation to ensure that it fits within the existing workflows and is accepted by users. Key messages • AI application indirectly affects the well-being of providers, particularly in rural healthcare settings. • A better AI application interface design that meets the expectations of providers is needed.

119 Cannabis-induced Anxiety Disorder in the Emergency Department

119 Cannabis-induced Anxiety Disorder in the Emergency Department

Comparative Analytical Study of Dinoprostone Gel and Hyaluronidase Injection for Induction of Labour in Term Primigravida in Tertiary Rural Medical Centre of Western Uttar Pradesh.

Objective: To compare the efficacy of intracervical dinoprostone gel and hyaluronidase injection for induction of labour in term primigravida. Materials and methods: This is a hospital based analytical prospective interventional study conducted in a rural tertiary care centre over a period of 18 months. A total of 70 patients who required induction of labour for one or another reason with Bishop score of less than 6 were included in the study. All the cases were randomly divided into two groups, Group A received dinoprostone gel and Group B received hyaluronidase injection. Chi square test & unpaired T test were applied for statistical analysis. Results: Time interval from induction to active phase of labour was comparatively shorter in group A than in group B (10.74 ± 6.17 vs 15.94 ± 7.1) and the difference was significant (p= 0.001). Time interval from induction to delivery time was comparatively shorter in group A than group B (14.84 ± 8.86 vs 21.33 ± 7.86) and difference was significant (P= 0.009). Maternal complications were more common in group A as compared to group B. Conclusion: This study showed that labour could be accelerated significantly by intracervical injection of hyaluronidase. Hyaluronidase injection has less maternal and fetal side-effects as compared to dinoprostone gel and can be a good choice for induction of labour.

Medical Services, Patient Age, and Level of Education on Its Influence on Diabetic Patients’ Level of Satisfaction

According to the Department of Health, diabetes is among the main causes of death among Filipinos. As a result, medical administrations must provide high-quality services. Patients, treatments, and particularly rural medical centers should all receive adequate screenings from the government. The goal of this study is to find out how satisfied diabetic patients are with the medical care they receive. Twenty-two (22) people with diabetes were included in the study. A survey will be utilized to gather information and data from a group of diabetic patients. The results show that: (1) there is no substantial difference in diabetic patients' satisfaction based on sex demographics; (2) there is no substantial difference in diabetic patients' satisfaction based on age demographics; (3) there is also no substantial difference in diabetic patients' satisfaction based on the establishment; and (4) there is a substantial difference between the patient's satisfaction and the medical services offered. When it comes to the score mean, diabetic patients' satisfactions are inside the extremely satisfied verbal description. The majority of the respondents were between the ages of 47 and 54. 12 females, 10 males, and 15 of them were in one medical establishment and the others were in the second. Despite their demographic differences, their satisfaction levels were quite close. Since there is a significant difference between the medical services dimension and the mean score of the overall medical structure and process is lower, there is a slight improvement for the medical establishments to focus on the medical structure and process, specifically the facilities, transportation convenience, and the length of waiting which the patients scored lower than the other parameters.

Barriers to metabolic bariatric surgery in adolescents: results of a qualitative study.

It is estimated that 4.5 million youth in the United States have severe obesity (SO). Metabolic and bariatric surgery (MBS) is the most effective and longitudinally durable treatment for adolescents with SO, but only an estimated 1600 adolescents undergo the procedure annually. To understand patients' perceptions and experiences with the barriers to MBS as an adolescent. This research was conducted at Children's Hospital Colorado, an urban academic medical center, and the University of Colorado Anschutz School of Medicine and Sanford Research, a rural medical center. We conducted 14 qualitative interviews with individuals who received MBS between the ages of 19 and 25 years in the last 5 years regarding the barriers to MBS they experienced as an adolescent. A formal qualitative analysis was conducted using the constant comparative techniques of grounded theory generally guided by Anderson's behavioral model of health service use. We identified 3 principal groups of barriers related to (1) a lack of information that MBS was an option and the absence of discussions about MBS with medical providers while an adolescent, (2) a lack of access to MBS primarily related to insurance coverage, costs, and family-related issues, and (3) a general stigma around MBS as a treatment for obesity. This study suggests that the primary barriers to MBS for adolescents with SO are related to a general lack of information about MBS, social stigma, and access issues related to costs that decrease or limit access.

The mediating effects of barriers to vaccination on the relationship between race/ethnicity and influenza vaccination status in a rural Southeastern Louisiana medical center.

Persistent disparities in influenza vaccination rates exist between racial/ethnic minorities and Whites. The mechanisms that define this relationship are under-researched. Surveys assessing barriers to vaccination were administered to outpatients in a rural medical center in Southeastern Louisiana. Survey responses were matched to patient medical records. Likert-style statements were used to measure barriers to vaccination. A mediation analysis assessing the relationship between race and influenza vaccination mediated by vaccination barriers was conducted. The self-reported influenza vaccination rate in those surveyed was 40.4%. Whites (45.5%) were more likely than racial/ethnic minorities (36.3%) to report receipt of an influenza vaccination (p = 0.02). Racial/ethnic minorities reported significantly higher vaccination barrier scores (p < 0.01). The relationship between race/ethnicity and vaccination was mediated by vaccination barriers, when controlling for provider recommendation and having at least one comorbid medical condition (natural indirect effect [NIE] p-value = 0.02, proportion mediated = 0.71). Barriers to vaccination mediates the relationship between race/ethnicity and vaccination status. Providers should focus on minimizing fears that the vaccine will cause illness and emphasize that the vaccine is safe and effective at preventing severe influenza-associated illness. Additional efforts should be made to improve accessibility of the influenza vaccine, including addressing costs of vaccination and expanding the number and types of settings where the vaccine is offered.

Understanding secondary overtriage for neurosurgical patients in a rural tertiary care setting

ObjectiveExcessive interfacility transfer to a tertiary care facility of minimally injured patients for subspecialty evaluation leads to overuse of resources and is referred to as secondary overtriage (SO). Little is known regarding the epidemiology of SO in rural settings, particularly for patients with a mild head injury who may be safely managed without admission to level I trauma centers. MethodsIn order to determine the rate of SO for neurosurgical patients with Glasgow Coma Scale (GCS) of 13–15 referred to a rural level 1 trauma center, we conducted a retrospective chart review of 224 patients evaluated for potential transfer to Dartmouth-Hitchcock Medical Center from January 1, 2014 through December 31, 2014. SO was defined as any admission where a patient was transferred from an outside facility, had a length of stay shorter than 48 h, did not require neurosurgical intervention, and was alive at the time of discharge. ResultsOf the 224 patients evaluated, 163 patients were transferred. Of the 163 patients included in this study, 43 (26.4%) met criteria for SO, 59 (36.2%) patients met criteria for intervention, and 61 (37.2%) patients met criteria for observation. ConclusionsApproximately a quarter of the total patients who are transferred to a rural level I trauma center for neurosurgical evaluation are minimally injured, do not require neurosurgical intervention, and are discharged within 48 h of presentation. Management at their referring facility with remote neurosurgical consultation is likely safe in this population. Understanding the rate of SO in neurosurgical patients and risk factors present in this group can better guide future transfer policies at rural medical centers.