Amanda Wilde (Host): Delivering healthcare through technologies like smartphones and computers improves access for patients, especially in a rural environment like the state of Arkansas. The program TeleSANE uses digital health for improving care for sexual assault victims.

We'll hear about how and why the TeleSANE program works with Sherrie Searcy Lyle, Director for the UAMS Institute for Digital Health and Innovation TeleSANE Program. Welcome to UAMS Health Talk, a podcast from University of Arkansas for Medical Sciences.

I'm Amanda Wilde, your host. Sherrie, welcome to you and thank you so much for being here.

Sherrie Searcy, BSN, RN,, SANE-A: Thank you so much for inviting me.

Host: First of all, you're a forensic nurse. I would love to know what that means and how you got into this field.

Sherrie Searcy, BSN, RN,, SANE-A: Great. Yes, I'd love to share. So by trade, I started into emergency nursing here at our level one trauma center here at UAMS. That is where I started into forensic nursing. So forensics is an umbrella for many subspecialties and the one that I serve the most would be a sexual assault nurse examiner. And I started with that education in my early career as a nurse as a sheer, just as a sheer opportunity, made available to me. And, what I did learn throughout my career in the ER is that there are, in nursing school, medical schools, medical forensic care is not part of the curriculum for medical schools or nursing schools.

And if it is part of the curriculum, it's just a few hours, which really does not promote that best practice that you could go out and actually provide that service to your patients, if you're serving in an area like an emergency room or an area that would need medical forensic exams. So in the ER, later, as I grew as a nurse, I started to be able to see the deficits, and forensic nursing was definitely down an avenue that I just started traveling down, and I was usually the one that took care of most of the victims of sexual assault that arrived to our ER. And I just realized that a lot of the things that we were not doing, not best practices that we were, depending on your provider, they may prescribe this, the next provider may prescribe or not prescribe certain medications.

 The patients would receive care based off the expertise of just that physician. So it's not standards of care for all patients that arrive. Or like if you had chest pain, you know, there's a protocol. If you have a stroke, there's a protocol. Medical forensic care, post sexual assault should also have a protocol.

Sherrie Searcy, BSN, RN,, SANE-A: So in In 2016, I was able to launch a protocol and education program for our emergency department. And as soon as that was launched and our physicians and nurses went through just a small training, a one and two hour training, it changed the standards of care and we started seeing outcomes change for patients.

 For example, you know, patients were getting MPEP prescribed, which is medications to prevent HIV. It's a protective medication and that was being prescribed more regularly. Patients would more likely be able to follow up. Chain of possession of their evidence was being followed through all the way from, you know, law enforcement to crime lab.

So many things were changing for our ER. Later into my career, you know, I've been an ER nurse for a long time. You can kind of get a moment where you're like, you know, I need to change. I really did not want to leave the patients that I knew would come in for sexual assault care, but I knew I needed to change.

So I went over to the teleSTROKE program at UAMS and kind of handed over the torch to a couple of my colleagues in the ER for SANE care. What's really cool is UAMS is a visionary organization, and in particularly IDHI, there's room for vision and growth. And they knew with me even coming over that my heart was really into forensic nursing, but I was really interested in the TeleSTROKE program.

And within six months, they allowed me to apply for a grant with our grant writers and we were able to kind of mimic TeleSANE, after the TeleSTROKE Program. What is really cool is UAMS has amazing relationships with most of all the hospitals across the state of Arkansas through the trauma system, and then through the stroke program.

So, we were pretty much able to kind of lay over what they're doing for stroke, kind of mimic that, and provide medical forensic consultation for hospitals across the state. So if a patient comes into their ER, we'd be able to get onto a telehealth device like a computer on wheels with a medical forensic camera so we can do some imaging and ensure that those patients, are receiving informed consent.

You go to a hospital and you sign all kinds of things and sometimes you don't know what you're really signing. We really pride ourselves in making sure that patients understand what their options are, that you laid that out, you know, their choice was taken away from them during the assault and us giving them options in their care and figuring out what is best for them.

Because even though we may think every crime should be reported, that may not be what that patient wants and we have to give them the control back and the autonomy back in their care and that is just the first steps toward healing.

And we used to receive reports all the time from Arkansas Coalition Against Sexual Assault, telling me about re-victimizations that would happen across the state where a patient would come into their ER either turned away saying, Hey, we don't do those types of exams here, or we don't have those services. Or if they do, they just, they're re-victimized by the inadequate care. And so TeleSANE, we don't have enough expertise in the state.

But the goal of TeleSANE, and there's two things, to provide immediate access to a medical forensic console so that these things for these patients now, they can get help and the help they need and to grow the field of forensics so that we can have on site forensic nurses across the state. Of course, we want nurses, boots on the ground in these communities, but that takes time.

And so what about the victims now? The survivors, they need help now, the ones that are coming in. So TeleSANE is an option to resolve that access so that equitable care can be done in all these communities, and currently we are serving 26 facilities, that is crisis centers and hospitals, for medical forensic consults.

And then we hope over the next several years to be in all the hospitals across the state of Arkansas so that there is truly a standard of care for sexual assault, forensic care, and that patients are not re-victimized, that we can promote better physical health outcomes, just legal proceedings, and of course, safer communities. At the end of the day, we hope that promotes a safer community to avoid these crimes continuing from the current assailant that are out there and doing these crimes.

Host: So you have really well described, how TeleSANE was formed, why, what the goals are, and how it works, and you've instituted all that along with a system of measurements to see how you're doing and how you can improve the program. So I want to get to some questions about sexual violence in general in Arkansas. How prevalent is sexual violence in Arkansas?

Sherrie Searcy, BSN, RN,, SANE-A: Well, you'll really be surprised, Arkansas ranks second in the nation for sexual assault. I told this recently into one of the Arkansas Nurses Association events and folks were just kind of flabbergasted at that number thinking that we're number two and we definitely don't want to be there. We want to change that and that's per capita. So, folks will think, oh, it's going to be in these bigger inner cities, but Arkansas ranks number two in the nation for sexual assault.

Host: So it's really important to look at the programs you're putting in there, I think, for you're all states looking at sexual assault because you deal with it a lot. You've described a system that you've had to build. Are there now notable gaps in the sexual assault response in Arkansas?

Sherrie Searcy, BSN, RN,, SANE-A: There are partners across the state that are doing their part. And I think medical forensic care has been just a missing link for forever. There's been just a couple areas, there's actually three crisis centers in the state that actually do provide on-site medical forensic exams. One of the three really serves to its fullest capacity at Sevier county, but it's just not enough. I mean, we're talking about maybe 90 percent of the state underserved medically. And so when you're the missing link to providing that, that evidence, that medical forensic documentation, the patients, supporting that patient's wellbeing in their communities and them being at more risk for re-victimization, especially if they don't get the help they need during their assault.

We're kind of being a gap filling services for the entire state of Arkansas and holding people accountable for the standards of care. There's not really been anybody out there holding people accountable for, I think there's been a lot of efforts out there, but it's not necessarily about making people like punitive damage if you're not doing this or this, but like giving you a pathway to be successful.

So I believe every hospital in the state of Arkansas wants to provide great care in every specialty that they're able to provide for their patients and their communities. But medical forensic care, they just don't have a pathway, a stepping stone that really supports them and to provide that. So TeleSANE comes in with all the prebuilt protocols, processes, standards of care, and we help them be successful in that implementation to take care of their own communites.

Host: TeleSANE really is, as you've just described it, a public service program on so many levels, but I want to make sure people understand the difference between a public service program and other medical programs. Can you Fill us in on the details?

Sherrie Searcy, BSN, RN,, SANE-A: We view TeleSANE as a public service. TeleSANE does not want to make profit off of somebody's trauma. Sexual assault. You didn't ask for sexual assault to happen to you. And we should be able to provide you, as the state of Arkansas, as a community, equitable access to medical forensic exams without causing you financial hardship.

So TeleSANE, we're all right now grant funded. We hope to have east state funded, here soon. And we do not want these survivors and victims across the state to have to go into debt based off crime that come against their bodies.

Host: Sherrie, thank you so much for what you've created to improve outcomes and to create systems to respectfully respond to victims of sexual assault.

Sherrie Searcy, BSN, RN,, SANE-A: You're welcome. Thank you so much for inviting me.

Amanda Wilde (Host): That was Sherry Searcy Lyle, Director for the UAMS, Institute for Digital Health and Innovation TeleSANE Program. For more information, visit idhi.uams.edu/telesane or email This email address is being protected from spambots. You need JavaScript enabled to view it.. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for additional topics of interest. This is UAMS Health Talk from the University of Arkansas for Medical Sciences.