AVERA eCARE EMERGENCY EVALUATING THE EFFECTIVENESS OF TELEMEDICINE - - PowerPoint PPT Presentation

AVERA eCARE EMERGENCY

EVALUATING THE EFFECTIVENESS OF TELEMEDICINE IN RURAL ED’S

MANDY BELL, MHA OFFICER OF INNOVATION & QUALITY AVERA eCARE MANDY.BELL@AVERA.ORG

AVERA eCARE EMERGENCY

Immediate video access to board-certified emergency physicians and nurses

SERVE HIGH-ACUITY EMERGENCY PATIENTS

T-PART PARTICIPATION TO DATE

56 56 74 75 94 98 100 114 137 147 154 164 165 177 184 188 197 202 287

Avera St. Michael's Hospital Harlan County Health System Redfield Community Memorial Hospital Avera St. Benedict Health Center Avera Weskota Memorial Hospital Avera St. Mary's Hospital Bowdle Healthcare Center Avera Wagner Community Memorial Hospital Johnson Memorial Health Services Avera Platte Health Center Avera Flandreau Hospital Sioux Center Health Avera Creighton Hospital Avera Holy Family Hospital Avera St. Anthony's Hospital Avera DeSmet Memorial Hospital Phillips County Hospital Pipestone County Medical Center Sakakawea Medical Center

T-PART Volume by Facility

339 134 77 38 2081

T-PART Volume by Complaint

Chest Pain Acute Myocardial Infarction Stroke Severe Sepsis or Septic Shock Other

2,669 Records Delivered to Date

PROPOSED AVERA RESEARCH

• Study impact on Timeliness of Care
• Study impact on Patient Disposition
• Evaluate impact on ER Staffing & Confidence
• Clinical Quality Research:

– Emergency Airway Management – Chest Pain/AMI Care – Stroke – Trauma Care – Sepsis – Mental Health

COLLABORATIVE PROJECTS

PURPOSE: Examine the rates of avoided transfers in rural emergency departments that adopted tele-emergency applications; and estimate the costs and benefits of using tele- emergency to avoid transfers. MATERIALS & METHODS:

• 9,048 Tele-emergency encounters across 85 rural hospitals within 7 states

between Oct. 2009 – February 2014

• Physicians indicated whether the transfer was avoided because of the tele-

emergency activation

• Cost-benefit analysis conducted from hospital, patient and societal

perspectives, and includes technology costs.

PATIENT DISPOSITION

PATIENT DISPOSITION

RESULTS: Physicians indicated 1,175 avoided transfers were attributed to tele-emergency. $5,563 in avoided transportation and indirect patient costs

• $,1739 in tele-emergency costs per avoided transfer

$3,824 in net savings to society

PATIENT DISPOSITION

CONCLUSION:

• Telemedicine has the potential to…

 Reduce the number of transfers of ED patients  Generate revenue for rural hospitals  Incur substantial patient savings

PURPOSE: Measure impact of Emergency Department-based telemedicine on timeliness of care in participating rural hospitals. MATERIALS & METHODS:

• 14 hospitals selected in 5 Midwest states (IA, KS, NE, ND, SD)
• Telemedicine cases matched 2:1 with controls based on age, diagnosis and

hospital

• Primary outcome: Time-to-provider
• Secondary outcomes: Emergency Department Length-of-Stay, Time-to-transfer

in those transferred to other hospitals

RESULTS: TIMELINESS OF CARE

Door-to-provider time was shorter in telemedicine patients by 6 minutes Telemedicine provider was first in seeing the patient in

42%

• f telemedicine

encounters …Of these cases, telemedicine was

14.7 minutes earlier

than local providers

Telemedicine First, 42% Local First

TIMELINESS OF CARE

TIMELINESS OF CARE

Dark gray bars show where telemedicine is consulted Light gray bars show where telemedicine was not consulted

Door-to-provider time by facility

CONCLUSION:

TIMELINESS OF CARE

• Telemedicine decreases ED door-to-provider time
• Among transferred patients, ED LOS at the first

hospital was shorter in patients who had telemedicine consulted

PURPOSE: Describe the effect of telemedicine on management and clinical

• utcomes for trauma patients in North Dakota.

MATERIALS & METHODS: Cohort study of adult (age ≥ 18 years) trauma

patients treated in North Dakota Critical Access Hospital (CAH) Emergency Departments (EDs) from 2008 to 2014. Multivariable generalized estimating equations were developed to identify associations between telemedicine consultations and availability and outcomes such as transfer, timeliness of care, trauma imaging, and mortality.

PATIENT DISPOSITION

PATIENT DISPOSITION

PATIENT DISPOSITION

Telemedicine was consulted for 11%

• f patients in

telemedicine- capable EDs & 4%

• f total trauma

patients

PATIENT DISPOSITION

Association between telemedicine utilization and ED LOS

(transferred and non-transferred patients):

• Patients who transferred had a 29.6 minute decrease in the LOS at the first hospital when

telemedicine was used, but no effect in those not transferred

• Telemedicine availability was associated with a 15.4 minute increase in ED LOS among transferred

and non-transferred

• Telemedicine use results in an earlier arrival time of 33.6 minutes

PATIENT DISPOSITION

CONCLUSION:

• ED-based telemedicine consultation is requested for the most severely

injured trauma patients

• Telemedicine consultation associated with more rapid inter-hospital

transfer

• Telemedicine availability associated with increased radiography use and

transfer

IMPROVING ACCESS

PURPOSE:

Real-time access to sepsis experts as part of an ED-based telemedicine network can decrease overall variation in care and improve clinical outcomes.

MATERIALS AND METHODS:

ED telemedicine initiatives for sepsis was implemented in tandem with ongoing system-wide process improvement in treating sepsis.

IMPROVING ACCESS

Results: Overall, the implementation project increased sepsis consultation rates by 64%.

Report highlights the importance of:

• System-wide implementation efforts to standardize sepsis

quality improvement activities

• Objectively defining consultation criteria
• Defining patient groups most likely to benefit from

telemedicine

• Clinician engagement and buy-in
• Understanding the availability of sepsis screening

laboratory tests – only 72% of CAH’s in Avera’s service area had access

IMPROVING ACCESS

CONCLUSION:

• Increasing telemedicine utilization for sepsis requires a

multi-pronged approach

• Objectively defining consultation criteria is critical to limit

alarm fatigue & identifying patient groups most likely to benefit from telemedicine

CURRENT WORK

• Discharge Disposition
• ER Staffing
• Mental Health
• Ongoing Education with

Tele-ED