SAFE-T System Telehealth Sexual Assault Nurse Examiner (TeleSANE) Consultation: Real-Time Changes to Medical Forensic Examinations for Adolescent and Adult Survivors in Rural and Underserved Communities

Background: Telehealth technology can expand access to expert sexual assault nurse examiner (SANE) care in rural and underserved areas. Research previously demonstrated that telehealth-supported sexual assault nurse examiner (teleSANE) intervention led to changes in examination methods and evidence collection practices among a pediatric population; however, little is known about the impact of the intervention on changes among adolescent and adult victims of sexual assault (SA). The purpose of this study is to examine how SAFE-T System TM teleSANE consultations influence medical forensic examination (MFE) recommendations and changes for adolescent and adult survivors of SA in rural and suburban communities. Methods: From June 2021 to September 2024, SAFE-T System teleSANEs provided 24/7 live telehealth consultations to local SANE-trained nurses at 11 hospitals in rural or suburban communities. A researcher-developed quality assurance tool was completed to assess the impact of the teleSANE consultation. Results: Analysis of 178 teleSANE consultations conducted by 18 teleSANEs partnered with 64 local SANEs across 11 hospitals. TeleSANE consultations resulted in changes across 7 domains and 12 subcategories: The 8 domains include: Patient-centered Communication (67.4%); Initial History/Data Gathering (42.1%); Forensic Evidence Collection (78.7%); Use of Multimethod Techniques (65.7%); Use of Adjunct Techniques (60.1%); Photo Documentation (51.1%) and Quality (59.6%); Post-assault Clinical Recommendations (43.8%); and Strangulation Evaluation (17.5%). Conclusions: Telehealth technology partnering expert teleSANEs with local SANEs in forensic specialty limited-access areas resulted in substantive changes to MFEs. These changes may reflect improved quality of care and enhanced forensic evidence collection.