Ramesh Karra

Interests

Research

Clinical decision making;Cognitive bias;Resource utilization;Evidence based physical exam

Teaching

Low resource technologies (EKG, POCUS);Resource utilization;Evidence Based Medicine

Courses

No activities entered.

Scholarly Contributions

Journals/Publications

• Karra, R., Rice, A., Hardcastle, A., Lara, J., Hollen, A., Glenn, M., Munn, R., Hannan, P., Arcaris, B., Derksen, D., Spaite, D., & Gaither, J. (2024). Telemedical Direction to Optimize Resource Utilization in a Rural Emergency Medical Services System. Western Journal of Emergency Medicine, 25(5). doi:10.5811/westjem.18427
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  Background: Telemedicine remains an underused tool in rural emergency medical servces (EMS) systems. Rural emergency medical technicians (EMT) and paramedics cite concerns that telemedicine could increase Advanced Life Support (ALS) transports, extend on-scene times, and face challenges related to connectivity as barriers to implementation. Our aim in this project was to implement a telemedicine system in a rural EMS setting and assess the impact of telemedicine on EMS management of patients with chest pain while evaluating some of the perceived barriers. Methods: This study was a mixed-methods, retrospective review of quality assurance data collected prior to and after implementation of a telemedicine program targeting patients with chest pain. We compared quantitative data from the 12-month pre-implementation phase to data from 15 months post-implementation. Patients were included if they had a chief complaint of chest pain or a 12-lead electrocardiogram had been obtained. The primary outcome was the rate of ALS transport before and after program implementation. Secondary outcomes included EMS call response times and EMS agency performance on quality improvement benchmarks. Qualitative data were also collected after each telemedicine encounter to evaluate paramedic/EMT and EMS physician perception of call quality. Results: The telemedicine pilot project was implemented in September 2020. Overall, there were 58 successful encounters. For this analysis, we included 38 patients in both the pre-implementation period (September 9, 2019–September 10, 2020) and the post-implementation period (September 11, 2020–December 5, 2021). Among this population, the ALS transport rate was 42% before and 45% after implementation (odds ratio 1.11; 95% confidence interval 0.45–2.76). The EMS median out-of-service times were 47 minutes before, and 33 minutes after (P = 0.07). Overall, 64% of paramedics/EMTs and 89% of EMS physicians rated the telemedicine call quality as “good.” Conclusion: In this rural EMS system, a telehealth platform was successfully used to connect paramedics/EMTs to board-certified EMS physicians over a 15-month period. Telemedicine use did not alter rates of ALS transports and did not increase on-scene time. The majority of paramedics/EMTs and EMS physicians rated the quality of the telemedicine connection as “good.”

Presentations

• Cagno, C. K., Karra, R., Viscusi, C. D., & Moynahan, K. F. (2023). ‘Sustaining Mentoring Relationships Longitudinally: One LC’s Intervention’. Learning Communities Institute 20th Annual Meeting. Baylor College of Medicine, Houston TX: Learning Communities Institute.
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  National conference that showcases the work being done across the country among Learning Communities.  

Other Teaching Materials

• Bulger, J., & Karra, R. (2024.

  Bulger Beck, Joy; Karra, Ramesh. 2024. "Responding to Microaggressions - EM." In The TTR Compendium - Responding to Microaggressions Edition 2, edited by Anna Neumeier, www.ttreducators/compendium. Transition To Residency Educators.

  . Transition to Residency Educators Compendium.
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  Curriculum for Transition to Residency course for 4th year medical students accross medical schools. 
• Karra, R. (2024. Article written based on a case of cutaneous leishmaniasis for the World Neglected Tropical Diseases Day (1/30/24) for a GH distinction track. . GH distinction track.
• Karra, R. (2022. Case of a patient presenting with hematuria who had rhabdomyolysis. Human Dx Project.
• Karra, R. (2022. Case of a pericardial effusion in a 17 year old female. Human Diagnosis Project.