Patient and Care Team Perspectives of Telemedicine in Critical Access Hospitals

Dinh, Jennifer; Ziegenfuss, Jeanette Y.; Siy, Jerome C; Doshi, Ameet; Platt, Yonatan; Dressen, John R

doi:10.12788/jhm.3412

Cited by 4 publications

(9 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Hub telehospitalists reported satisfaction with the program, and they perceived the quality of care to be comparable to face‐to‐face encounters; their responses were consistent with those previously reported in an evaluation of telemedicine acute care by JaKa et al 20 Spoke‐site staff, however, had a mixed level of satisfaction, which was different from responses reported by JaKa et al 20 The primary challenges encountered were technological and communication issues, differences in cultures of care between the hub and the spoke sites, and buy‐in from frontline staff. Differences in expectations and unclear role definitions between the local APP and the telehospitalist were identified as contributors to dissatisfaction with the program by the nursing staff.…”

Section: Discussionsupporting

confidence: 82%

“…Telehospitalist services (THS) can help deliver high‐quality care to rural residents locally, decrease travel expenses, support hospital volume, and increase healthcare capacity in response to a pandemic 14,17,18 . Only a few studies have described THS (mostly with overnight or cross‐coverage models directed to CAHs), and clinical outcomes have been inconsistently reported 17,19‐21 . Furthermore, no program has been conducted within an integrated health system akin to the VHA.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Implementing a Telehospitalist Program Between Veterans Health Administration Hospitals: Outcomes, Acceptance, and Barriers to Implementation

Gutiérrez

Moeckli

Holcombe

et al. 2021

Journal of Hospital Medicine

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionsupporting

confidence: 82%

mentioning

confidence: 99%

Implementing a Telehospitalist Program Between Veterans Health Administration Hospitals: Outcomes, Acceptance, and Barriers to Implementation

Gutiérrez

Moeckli

Holcombe

et al. 2021

Journal of Hospital Medicine

View full text Add to dashboard Cite

show abstract

“…12,23,27,29 JaKa showed that care teams overwhelmingly recommended telemedicine (clinicians = 100% and nurses 95%), were satisfied with communication (>90%), and saw improved cross-coverage and admission processes. 23 Gutierrez 20 reported high satisfaction among telehospitalists (100%) but only 58% satisfaction among clinicians and 30% for nurses at the receiving site. 20 Qualitative evaluations provided additional insight into the value perceived by care teams on telemedicine programs.…”

Section: Resultsmentioning

confidence: 99%

“…Some studies reported other process and utilization metrics including number of consultations 34,35 and efficiency or timing metrics 27,35,36 . with most showing no differences or improvement. Satisfaction and acceptance from patients, providers, or both was reported in nine studies 12,20,23,27,29,31,34–36 . Most showed that providers and staff had a high rate of satisfaction and felt that telehospitalists followed standards of care with some reporting improved patient care 12,23,27,29 .…”

Section: Resultsmentioning

confidence: 99%

A systematic review of telehealth applications in hospital medicine

Gutiérrez

Rewerts

CarlLee

et al. 2022

Journal of Hospital Medicine

View full text Add to dashboard Cite

Background: Despite the proliferation of telehealth, uptake for acute inpatient services has been slower. Hospitalist shortages in rural and critical access hospitals as well as the COVID-19 pandemic have led to a renewed interest in telehealth to deliver acute inpatient services. Understanding current evidence is crucial for promoting uptake and developing evidence-based practices.Objective: To conduct a systematic review of telehealth applications in acute inpatient general medicine and pediatric hospital wards and synthesize available evidence. Data Sources: A search of five databases (PubMed, CINAHL, Embase, Scopus, and ProQuest Theses, and Dissertations) using a combination of search terms including telemedicine and hospital medicine/inpatient care keywords yielded 17,015 citations. Study Selection and Data Extraction: Two independent coders determined eligibility based on inclusion and exclusion criteria. Data were extracted and organized into main categories based on findings: (1) feasibility and planning, (2) implementation and technology, and (3) telehealth application process and outcome measures. Results: Of the 20 publications included, three were feasibility and planning studies describing the creation of the program, services provided, and potential cost implications. Five studies described implementation and technology used, including training, education, and evaluation methods. Finally, twelve discussed process and outcome measures, including patient and provider satisfaction and costs. Conclusion:Telehealth services for hospital medicine were found to be effective, well received, and initial cost estimates appear favorable. A variety of services were described across programs with considerable benefit appreciated by rural and smaller hospitals.Additional work is needed to evaluate clinical outcomes and overall program costs.

show abstract

“…Medicine, a highly relationship‐based “team sport,” is another barrier to successful implementation. Whether serving as supervisor or primary attending (as noted in the evaluation by JaKa and colleagues 5 ), the telehospitalist must be “on stage” for both patients and remote spoke colleagues. In our experience, telehospitalists also practice in‐person daytime hospital medicine at spoke sites; this further enhances their relationship and connection with the spoke community and likely contributes to high satisfaction by hub hospitalists and spoke patients and nurses.…”

mentioning

confidence: 99%