Emergency Telemedicine Supported by Onsite Emergency Responder Technicians Reduces EMS Transports, Hospitalizations, and Total Patient Costs from Skilled Nursing Facility
MeSH SubjectsEmergency Medicine
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PublisherThe University of Arizona.
DescriptionA Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.
AbstractBackground: Skilled nursing facility (SNF) residents tend to be older adults and have increased medical complexity and acuity, making them more likely to access the emergency department (ED) and get hospitalized. Several programs have been created with the intention to increase treatment of medical problems on-site and decrease rates of transfer from SNFs to acute hospitals. An Emergency Telemedicine Service (ETS) is designed through interprofessional collaboration with remote emergency medicine physicians and on-site emergency technicians. This framework allows for multi-provider evaluation, navigation, and treatment of patients within SNFs with potential avoidance of transfer to an ED. Objective: To examine the efficacy of an Emergency Telemedicine Service in reducing unplanned EMS to ED transports from skilled nursing facilities (SNFs) and hospitalizations. Secondarily, we aimed to determine which chief complaints were most commonly to be transferred to the ED compared with those more likely to be treated on-site. Methods : A before and after study design was used to examine the implementation of ETS at a single 202 bed SNF. A six month pre-implementation period from July 1, 2015 to December 31st, 2015 was compared to July 1, 2016 to December 31st, 2016. Data regarding the number of ED transfers, hospital admissions, and cost for patients in the SNF were collected from medicare databases. Medical record demographics including patient age, gender, chief complaint, and disposition, were examined for patients who utilized the ETS. Results: The rate of ED transport per patient was 1.10 before implementation compared to 0.97 after implementation; a decrease of 11.69% (95% CI 8.32 - 15.0). ED costs decreased by 33.6% ($2,708, p=0.016) per patient visit. The rate of hospital admission per patient was 0.77 before implementation compared to 0.65 after implementation; a decrease of 15.37% (95% CI 11.6 - 19.1). Inpatient admission costs decreased by 9% ($2,175, p=0.392) per patient. Additionally, the overall monthly cost per patient at the SNF also decreased by 4.42% ($6,345.51 vs $6,064.83) regardless of whether they required the use of the ETS. The average age of patients who utilized the telemedicine service was 80.78 (SD=11.86). 56.44% (n=57) of patients were female and 43.56% (n=44) were male. The most common chief complaint category was respiratory, with musculoskeletal and general complaints also being frequent. Musculoskeletal related complaints required the most transfer, along with cardiovascular/lymph and respiratory complaints. In contrast, all male reproductive, and most digestive, and mental health-related complaints were successfully managed with on-site resources. Conclusions: Through the use of an advanced Emergency Telemedicine Service in a single SNF, there was a reduction in ED transfers and a significant decrease in the cost for SNF residents transferred to the ED. Keywords: Skilled Nursing Facility, Geriatrics, Emergency Medical Services, ET3, Telemedicine