Telemedicine at SNF Improves Care, Reduces Readmissions
When a 92-year-old patient developed a fever and showed signs of weakness one February night, past protocol may have meant a precautionary trip to the nearby emergency department (ED).
The Northwell Health Stern Family Center for Rehabilitation in Manhasset, N.Y., is a skilled nursing facility (SNF) that places in the top 10 percent for overall quality, based on its five-star rating on the Centers for Medicare & Medicaid Services’ Nursing Home Compare site. However, until recently the 256-bed subacute care facility did not have the capability to provide real-time access to critical care physicians or intensivists around the clock. That all changed earlier this year with the launch of a telemedicine program that provides clinical bedside support to assess and diagnose conditions and minimize hospital readmissions.
Through the use of telemedicine, nurses and other caregivers at Stern connect with doctors at Northwell Health’s Telehealth Center in Syosset, N.Y. Via two-way cameras and monitors mounted on carts, critical care doctors in Syosset assess and interview patients, determining appropriate care. They can access information about the patients’ vital signs and check heartbeats, among other tasks. Electronic medical records are available to support decision making. The physicians can see and communicate with patients, their families, and clinicians at Stern.
In the case of the 92-year-old man, the medical director at Northwell’s electronic intensive care unit assessed the patient and, within a matter of minutes, directed nurses at Stern to start an IV line. Antibiotics were given and diagnostic tests ordered. The team was able to get lab results in two hours thanks to Stern’s newly augmented lab capabilities. And an unnecessary hospitalization was avoided.
Making Better Decisions for Patients
We are using telemedicine to improve the quality of bedside care while reducing the costs—both physical and financial—that are associated with unnecessary hospital readmissions.
Telemedicine makes it possible to bring physician-level care to the building when doctors are off the premises. That means patients can remain at the facility, avoiding the stress associated with moving to a hospital. Staff members are credentialed in using the technology and know when to use this resource (for example, in cases of chest or abdominal pain).
Patients so far have been very accepting of this technology and appreciate the ability to interact with physicians without the inconvenience of a trip to a hospital. We’ve been using telemedicine about five times a week so far and have helped some patients avoid trips to the ED.
Previously, an overnight medical question at Stern would necessitate calling doctors at home, where they had to make a determination over the phone about the next step for care. Telehealth allows us to make better decisions for our patients.
Staying Ahead of the Curve on Readmissions
The cost-related benefits also are important. Hospitals are being penalized if their patient readmission rate is high, and this approach is one way to keep that rate down. Of course, if a patient needs the kind of care that is available only in a hospital, then readmission is the logical step. But for patients who do not require hospital care, improved, expedited access to a physician is a significant factor in ensuring a return to health.
Telemedicine taps into the strength of Northwell Health’s larger, connected health system. We are committed to providing high-quality care and a satisfactory patient experience by bringing technology and people together to improve outcomes.
Howard Guzik, MD, is medical director, Northwell Health Stern Family Center for Rehabilitation, Manhasset, N.Y.
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