Journal article
Implementing a Telehospitalist Program Between Veterans Health Administration Hospitals: Outcomes, Acceptance, and Barriers to Implementation
Journal of hospital medicine, Vol.16(3), pp.156-163
03/01/2021
DOI: 10.12788/jhm.3570
PMCID: PMC7929612
PMID: 33617436
Abstract
BACKGROUND: Telehospitalist services are an innovative alternative approach to address staffing issues in rural and small hospitals.
OBJECTIVE: To determine clinical outcomes and staff and patient satisfaction with a novel telehospitalist program among Veterans Health Administration (VHA) hospitals.
DESIGN, SETTING, AND PARTICIPANTS: We conducted a mixed-methods evaluation of a quality improvement program with pre- and postimplementation measures. The hub site was a tertiary (high-complexity) VHA hospital, and the spoke site was a 10-bed inpatient medical unit at a rural (low-complexity) VHA hospital. All patients admitted during the study period were assigned to the spoke site.
INTERVENTION: Real-time videoconferencing was used to connect a remote hospitalist physician with an on-site advanced practice provider and patients. Encounters were documented in the electronic health record.
MAIN OUTCOMES: Process measures included workload, patient encounters, and daily census. Outcome measures included length of stay (LOS), readmission rate, mortality, and satisfaction of providers, staff, and patients. Surveys measured satisfaction. Qualitative analysis included unstructured and semi-structured interviews with spoke-site staff.
RESULTS: Telehospitalist program implementation led to a significant reduction in LOS (3.0 [SD, 0.7] days vs 2.3 [SD, 0.3] days). The readmission rate was slightly higher in the telehospitalist group, with no change in mortality rate. Satisfaction among teleproviders was very high. Hub staff perceived the service as valuable, though satisfaction with the program was mixed. Technology and communication challenges were identified, but patient satisfaction remained mostly unchanged.
CONCLUSION: Telehospitalist programs are a feasible and safe way to provide inpatient coverage and address rural hospital staffing needs. Ensuring adequate technological quality and addressing staff concerns in a timely manner can enhance program performance. (C) 2021 Society of Hospital Medicine
Details
- Title: Subtitle
- Implementing a Telehospitalist Program Between Veterans Health Administration Hospitals: Outcomes, Acceptance, and Barriers to Implementation
- Creators
- Jeydith Gutierrez - Iowa City VA Health Care SystemJane Moeckli - Iowa City VA Health Care SystemAndrea Holcombe - Iowa City VA Health Care SystemAmy Mj O'Shea - Iowa City VA Health Care SystemGeorge Bailey - Iowa City VA Health Care SystemKelby Rewerts - Iowa City VA Health Care SystemMariko Hagiwara - Roy J. and Lucille A. Carver College of MedicineSteven Sullivan - Tomah VA Medical CenterMelissa Simon - Tomah VA Medical CenterPeter Kaboli - Iowa City VA Health Care System
- Resource Type
- Journal article
- Publication Details
- Journal of hospital medicine, Vol.16(3), pp.156-163
- DOI
- 10.12788/jhm.3570
- PMID
- 33617436
- PMCID
- PMC7929612
- NLM abbreviation
- J Hosp Med
- ISSN
- 1553-5592
- eISSN
- 1553-5606
- Publisher
- Frontline Medical Communications
- Number of pages
- 8
- Grant note
- CIN 13-412 / Health Services Research and Development Service through the Center for Access and Delivery Research and Evaluation 13368 / Department of Veterans Affairs, Veterans Health Administration, Office of Rural Health, Veterans Rural Health Resource Center-Iowa City; US Department of Veterans Affairs
- Language
- English
- Date published
- 03/01/2021
- Academic Unit
- Neurology; Epidemiology; General Internal Medicine; Internal Medicine
- Record Identifier
- 9984359860302771
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