Since Cindy Forbes, R.N., became a sexual assault forensic nurse examiner seven years ago, she has been the only specialized examiner in her rural community of Lakeport, California.
"If my victims aren't getting rape exams here, they aren't getting rape exams," said Forbes, an emergency department nurse at Sutter Lakeside Hospital, in a video for the National TeleNursing Center.
Lakeport is not unique.
Nurses that are trained to provide expert care to sexual assault victims are a highly valuable resource—they have specialized training in forensic examination and understand best practices in evidence collection. There are too few of these nurses, called Sexual Assault Nurse Examiners (SANE), nationally and many communities have no access to such expertise.
For hospitals that don’t have forensic nurses, it often falls on ER staff to perform a forensic exam for sexual assault patients. Or patients can travel long distances to a hospital that has a trained examiner on staff.
But Pennsylvania State University has found success addressing this shortage and improving care for sexual assault victims with the help of a technological solution: Telehealth.
“We hear stories all the time from healthcare providers who say that when they go to perform the exam they are opening a forensic kit and reading the instructions on what they are supposed to do. Now imagine as a patient what that experience must be like,” Sheridan Miyamoto, director of the Penn State Sexual Assault Forensic Examination Telehealth (SAFE-T) Center, told Fierce Healthcare.
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It's among a growing number of states and hospitals that have found success using telehealth to connect rural and remote healthcare providers with SANEs, who are trained to collect evidence and provide expert testimony in court proceedings.
“It is all under the patient’s control,” Miyamoto said. “We are adding in a second expert and a layer of quality where the focus is what’s best for the patient.”
The Massachusetts Department of Public Health was the first agency to launch a national telenursing center to support on-site nurses performing sexual assault exams. The center, funded by a grant from the U.S. Department of Justice's Office for Victims of Crime, provides telehealth services to survivors of sexual assault in six communities in California, Arizona and Massachusetts.
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The telehealth service provides multiple benefits—sexual assault patients are provided what’s called “trauma-informed” expert forensic nursing care and nurses on site receive training and support and it helps to sustain a forensic nurse workforce.
“Every nurse deserves peer support and every victim deserves expert care—no matter where you live,” Miyamoto said.
The technology also provides better images and video that will strengthen forensic evidence collection and documentation for district attorneys and law enforcement, program officials said.
Miyamoto and her team spent a year getting the program off the ground by establishing partnerships with hospitals and ensuring high levels of security for the documentation and technology connections. “One lesson learned with telehealth is that if it’s not something the community wants, then you can put equipment in but doesn’t mean they will use it. It’s important to go where the service is seen as valuable,” she said.
Miyamoto started her work in this area almost two decades ago at UC Davis where she helped establish a telehealth consultation program for clinicians at rural hospitals to improve forensic exams. A UC Davis study of that program found a higher quality of care at hospitals with the telehealth program. Clinicians with access to expert nurses provided more thorough and nuanced forensic exams, improving their ability to gather evidence and to make an accurate diagnosis, she said.
Nationwide shortage of forensic examiners
The shortage of sexual assault nurse examiners is a nationwide problem, according to a 2016 Government Accountability Office report (PDF). Several challenges hinder efforts to maintain a supply of trained examiners, the report said, including limited availability of training and weak stakeholder support for examiners.
On average, there are 321,500 victims of sexual assault each year in the United States, according to data from the Rape, Abuse and Incest National Network. There are currently 4,460 forensic nurses in the U.S., according to the International Association of Forensic Nurses.
Low retention of sexual assault nurses also is a major challenge, according to the report.
The telehealth programs also help to address burnout, a prevalent issue among forensic examiners. Sexual assault examinations can be technically and emotionally difficult, and staff performing these exams are often difficult to retain.
In Wisconsin, officials estimated that although 540 SANEs were trained over a two-year period, only 42, less than 8%, were still practicing in the state at the end of those two years. “It’s common for people to leave the field in one year after training,” Miyamoto said.
Telehealth programs can help address many of these challenges, Miyamoto said.
Nurses can receive continuous education and training through the telehealth consultations and also receive ongoing peer-to-peer mentorship. At the UC Davis program, the telehealth program helped to address burnout and more nurse examiners stayed in the work longer, Miyamoto said.
Texas also is establishing a statewide telehealth network to connect rural and remote healthcare providers with the 357 sexual assault nurse examiners in the state. "Every survivor of sexual assault deserves compassionate care and justice—regardless of where they live," Texas State Senator Jane Nelson, who drafted the law, said in a statement. The telehealth network will help provide expert care and ensure forensic evidence is collected in a manner that will stand up in court, Nelson said.
St. Peter's Health Partners in Albany, New York recently launched a telehealth program in partnership with United Concierge Medicine to improve medical care for sexual assault survivors. The pilot program launched in 46 New York hospitals without certified forensic examiners.