Telehospitalists address rural hospital staffing shortages

In the past year, e-consults, virtual diagnosis, and virtual postoperative care have become the new normal. By limiting in-person exposure to COVID-19, telemedicine offers a safe way to deliver care for both patients and medical providers. Although the end of the pandemic is in sight, a recent publication found that telemedicine is a cost-effective and satisfactory alternative to in-person care, especially for rural facilities, and should remain an option for expansion post-COVID.

Dr. Gutierrez Perez

Jeydith Gutierrez Perez, MD, clinical assistant professor in General Internal Medicine, lead the study alongside a team of researchers, analysts, and providers from the Department of Internal Medicine, the VA’s Center for Access Delivery Research and Evaluation (CADRE), and the Tomah VA Medical Center. The team’s findings were published in the Journal of Hospital Medicine.

The project aimed to identify whether telehospitalist services could deliver high-quality care to rural residents at local facilities, decreasing travel costs, and increase capacity for rural and small hospitals facing staffing issues. The team tested both the clinical outcomes and staff and patient satisfaction for a year in one ten-bed VA Medical Center in Wisconsin. Virtual video conferencing was used to connect a hospitalist physician to a local nurse practitioner, advanced practice provider, or physician assistant and to patients. 

The team measured pre- and post-implementation processes such as workload, patient encounters, and daily census. Furthermore, they measured outcomes such as length of stay, readmission rate, mortality, as well as provider, staff, and patient satisfaction. 

With telehealth implemented, the hospital experienced significant positive reductions in certain measures. The average daily census decreased from 5 patients per day to 3.1 and length of stay from 3.0 days to 2.3. Perceptions of the program by participants revealed strengths and areas for improvement. Staff and providers at both the “hub” and “spoke” sites perceived the service as valuable and found communication easy, but were often frustrated by the technology. Although patients echoed the challenges with technology and communication, scores from them on their care coordination questions increased while some other metrics of patient satisfaction stayed unchanged.

The authors conclude that telehospitalist medicine is a “feasible and safe approach to inpatient services.” They recommend expanding future studies to incorporate multiple spoke sites and one or more hubs. 

Researchers on this project include Jane Moeckli, PhD; Andrea Holcombe, PhD; Amy MJ O’Shea, PhD; George Bailey, BS; Kelby Rewerts; Mariko Hagiwara, MD; Steven Sullivan, APNP MSN; Melissa Simon, DO; and Peter Kaboli, MD, MS.

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