Assessing The Impact Of Telemedicine On Nursing Home Transfers
Starting January 2016, we implemented a three-month pilot telemedicine pilot at a 300-bed skilled nursing facility in Staten Island, New York. A board-certified emergency medicine doctor was available via telemedicine video conferencing for consultation every weekend (from 5 P.M. Friday through 7 A.M. Monday). The telemedicine doctors were granted clinical privileges at the facility. A comprehensive telemedicine technology system including a digital stethoscope was introduced at the pilot site. The facility’s skilled nurses were trained in the use of the telemedicine equipment. Pursuant to agreed upon criteria, facility staff contacted the telemedicine team when a change in condition was identified.
The aim of this pilot was to implement telemedicine in the nursing home setting, and to measure the effect of telemedicine in reducing preventable hospital transfers.
The baseline transfer rate from January through March 2015 was 2.93 transfers per 1,000 resident days. During the three-month pilot period, the transfer rate was 1.83 per 1,000 resident days, a 38% decrease. Using the paired t-test, we compared transfer rates from the baseline period to the pilot period yielding a statistically significant reduction in transfers (p=0.004). When excluding the first month’s performance to account for staff adjusting to the new process, there was a 50% decrease in transfers from 2.93 transfers per 1,000 resident days to 1.47 transfers per 1,000 resident days. Similarly, when comparing the three months that immediately preceded the pilot, the transfer rate declined 31%, from 2.64 per 1,000 resident days to 1.83 per 1,000 resident days (p=0.02).
Telemedicine is a valuable tool to decrease hospital transfers from skilled nursing facilities. We hypothesize that the telemedicine consultation and ensuing clinical orders allowed the skilled nursing facility to utilize their clinical capabilities to their fullest capacity by managing medically complex patients on-site as opposed to initiating preventable hospital transfers. The Minimum Data Set scores derived from comprehensive quality assessments were unchanged during the pilot period. When averaging the top three rehospitalization admission diagnoses, this reduction has the potential to save $65,000 per 100 patients per month or $2.4 million for this facility.