Implementing Telemedicine in a SNFs to Reduce ED Visits

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With the graying of America, there has been a rise in demand for senior housing. In response to this trend, skilled nursing facilities have become an increasingly popular choice among seniors. According to the National Institute on Aging, there are currently over 6,000 SNFs licensed in the U.S., and that number is expected to continue growing. In order to provide the highest quality of life for the seniors who live there, a skilled nursing facility should implement telemedicine as part of an emergency department reduction plan. Today we will discuss how implementing telemedicine can reduce emergency department visits by providing patients with virtual access to doctors and other medical professionals outside of normal business hours.

Today, more and more patients’ care is provided by skilled nursing facilities after they leave the hospital than ever before. Hospitals are required to provide only the most intensive or acute care and then transfer the patient to a setting with lower costs. As a result, skilled nursing facilities accept patients who are more fragile and complicated than in the past. According to a recent NIH study, “The proportion of residents living with high care needs increased by 8.7% between 2007 and 2017.

What is Telemedicine or Virtual Healthcare?

Virtual Healthcare sometimes called Telemedicine refers to electronic communication and information technology to provide medical diagnosis and treatment. Simply put, telemedicine is the practice of connecting patients with doctors and other medical professionals remotely. This is often done through telemedicine healthcare solutions like Hucu.ai HIPAA compliant cloud-based application for video conferencing, text messaging, and digital medical records. Telemedicine can treat a wide range of ailments, including chronic diseases like diabetes, heart disease, and respiratory disease. It can also be used to treat acute conditions like infectious diseases, musculoskeletal pain, and sports injuries. Using telemedicine, medical professionals can deliver personalized care to patients in various settings, including their homes and workplaces.

The Use of Telemedicine in SNFs

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Paraprofessionals, such as nursing assistants supervised by registered nurses, make up a large portion of staffing at skilled nursing facilities. Physicians are usually situated outside the facility and visit once or twice weekly to supplement video or phone consultations. Placing medical paraprofessionals in charge of patients is difficult since taking care of their needs frequently goes beyond the limitations and abilities of their licensure. Because of this, patients are frequently taken to emergency departments for treatment. The skilled nursing/emergency department loop causes stress for the patient, the hospital, and the skilled nursing facility.

Telemedicine is seen as an effective technique to cut down on the skilled nursing/ER circuit. The only requirement for telemedicine is Telehealth software, a computer with a camera that connects a patient to a nursing assistant at the facility with a live video link (physician or nurse). This method eliminates the requirement for patients to be transported to the ER for non-emergency situations.

The cost of telemedicine technology is the most common barrier cited to its adoption.  However, an easily affordable iPad with Zoom, for example, might be adequate at the bedside. The key to successful telemedicine is often operational. Having on-site physicians or nurses available to consult with patients is important. Documentation must be maintained. After-hours coverage, physicians or nurses may staff the telemedicine platform and chart in a current Electronic Medical Record. Physicians can assess the situation using telemedicine from home and drive to the facility only if “hands-on” treatment is required. In short, telemedicine can be an inexpensive and effective tool for reducing transport and improving patient access to physicians.

Tips for Successful Telemedicine Programs

Your facility has decided to adopt telemedicine. Here are some pointers to help you get started and keep telemedicine running there. Senior leadership should become engaged in promoting telemedicine. Incentives should be offered to encourage employees to use the system. Training should be done with participation of senior leaders to encourage participation.

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The barriers to adoption are often staff resistance to change and fear of technology. Being HIPAA-compliant, Telemedicine software is more complex to use than a website. Password forgetfulness was one of the most common problems. Robust training should be provided to overcome the barriers. A workflow list should be posted in multiple locations to support the deployment and use. There are five key steps to ensure a successful implementation.

  • After one week, month, or quarter is finished, track and report the number of telemedicine visits. 
  • Calculate the number of visits that resulted in an emergency department bypass and the number of those that did not. 
  • Revisit the senior management objectives. Are they being fulfilled? 
  • Talk to personnel to see if staff members believe the technology is being used correctly. 
  • Modify methods, duties, and training based on the information. Re-educate personnel. 

Soon, your clinic will be so proficient in telemedicine that it can expand to other applications such as family visits, remote patient monitoring, and specialist consultations. 

Problems with Skilled Nursing Facilities

There are several problems with SNFs that can be overcome with the implementation of telemedicine. First, because SNFs that primarily serve patients with acute conditions, are required to have an emergency department with a hospital-level care team. The only problem is that many SNFs do not have a full-time emergency department, so patients have to go to a hospital emergency room when they have a serious health issue. For example, let’s say that a patient at an SNF develops a serious infection, and the doctors at the facility don’t have the staff or expertise to treat the disease. In this scenario, the patient would have to go to the nearest emergency room, which would likely be 30 minutes away or more.

Benefits of Telemedicine in Skilled Nursing Facilities

Beyond the obvious benefit of reducing the number of patients who have to go to the emergency department, there are several other advantages associated with implementing a telemedicine program at an SNF. For one, telemedicine provides a more convenient option for inpatient care. In fact, many patients prefer the privacy of their rooms over the clinical settings of a hospital or urgent care clinic. When patients go to an emergency room, they often have to wait for hours, or even days, before seeing a doctor. At an SNF, patients can receive virtual access to medical professionals, like physicians and nurses, anytime, day or night. Virtual access also allows patients to stay in their rooms and keep their dignity. Virtual access also allows patients to speak with a physician rather than be examined by a physician assistant.

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How to Implement Telemedicine in an SNF

There are five steps to implementing telemedicine at an SNF:

  1. Physicians will need to pair with remote providers to handle the volume of virtual visits at the facility.
  2. Physicians will also need to create an online medical record system for patients.
  3. Physicians need to train staff and patients using the online medical record system.
  4. The facility will need to install and set up the necessary infrastructure for virtual visits, including a video conferencing system and computer(s) with high-speed internet.
  5. The facility must promote its new virtual services, including 24/7 virtual urgent care and virtual visits with specialists.

Conclusion

Overall, there are many benefits associated with implementing telemedicine at an SNF, including lower healthcare costs, greater access to medical services, and improved quality of life for patients. There is a growing trend toward adopting telemedicine in healthcare settings and among healthcare providers. More research needs to be conducted on how to utilize telemedicine in various settings best. However, it is expected that the adoption of telemedicine will increase in the coming years as research and implementation are expanded.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8681075/

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