One in four hospital patients discharged to a skilled nursing facility (SNF) returns to the emergency department (ED) within 30 days. The consequences of these readmissions include:
- Financial penalties for the SNF and hospital
- Physical stress for the patient
- Emotional stress for the family
- Financial burden for the patient and family due to transfer costs
Interestingly, data indicates that up to two-thirds of these transfers are unnecessary and that many may be avoided by involving a physician in the decision.
Avoidable readmissions often occur when there’s no physician on-site or available to discuss a patient's case. In these instances, a concerned nurse will often send the patient to the hospital.
Vituity has found that telehealth is an effective way to enhance physician engagement and involvement with SNF nurses and patients. This in turn may prevent some uncomfortable and costly hospital transfers.
What Is Telehealth?
SNF telehealth involves videoconferencing among a physician, their SNF nurse colleague, and/or the SNF patient for whom they manage care. Data and feedback suggest that this method of communication improves relationships among nurses, patients, and physicians and ultimately reduces hospital transfers.
Like Skype or FaceTime, telehealth requires minimal hardware and can be very user-friendly. Rather than calling a physician by phone, a nurse can pick up an iPad or device of their choosing to initiate a videoconference with the doctor.
In addition to face-to-face communication, most telehealth platforms allow screen sharing and prescribing. Depending on program's capabilities, the off-site physician may also be able to manipulate peripheral devices or order labs and diagnostics. Additionally, telehealth platforms facilitate the collection of data that can be used to enhance care.
A SNF-Hospital Partnership to Improve Care
To help reduce costly transfers and readmissions, Vituity hospitalists at Saint Agnes Medical Center in Fresno, Calif., partnered with a nearby SNF, Sierra Vista Healthcare Center. The partnership brought Vituity hospitalists into the SNF several days a week for routine rounding. SNF nurses also had virtual access to the hospitalists via Vituity’s telehealth program, On Duty.
Today, instead of making a phone call, a nurse can use On Duty to immediately connect to a patient’s managing physician. To initiate a videoconference, the nurse simply hits the "START VISIT" button on a tablet or laptop and is connected to the doctor within minutes.
Since the program's implementation, ED transfers from Sierra Vista have decreased substantially. Throughout the brutal 2018 flu season, Sierra Vista sent far fewer patients to the hospital than other SNFs in the region.
Nursing typically initiates an On Duty call to discuss medical matters with a physician. But family members can also benefit from conferencing with the hospitalist.
Recently, a Sierra Vista nurse connected a Vituity hospitalist with a patient's wife who wanted to remove her husband from the facility against medical advice. The provider explained the patient's condition and why he needed a higher level of care than he could receive at home. The wife was reassured by the quick, caring response of the nurse and hospitalist. After the videoconference, she agreed to keep her husband at the facility.
A Bright Future
The partnership between the St. Agnes hospitalists and Sierra Vista SNF nurses has been very effective at preventing hospital readmissions. We recently analyzed the cases of 14 SNF patients who were considered for an ED transfer. Following a telemedicine consult, seven were cared for at the SNF, and three were transferred to a lower level of care. This represents a 70 percent reduction in ED transfers.
Use of On Duty to improve SNF care is expanding. Vituity hospitalists now support SNFs in communities around the country. Many of these facilities have adopted On Duty to enhance care and decrease unnecessary readmissions.
SNF nurses and hospitalists praise the telehealth program, saying it promotes collegiality and teamwork. Both sides enjoy having more opportunities to collaborate and discuss their most complex cases.
The development of our SNF program exemplifies Vituity's agile approach to telehealth. Our dedicated team helps hospitals, health systems, payers, and employers create tailored solutions to meet their needs and drive results.
Vituity Telehealth can support many areas of your health system, including the emergency department, inpatient units, ICU, urgent care, and receiving SNFs. Our telemedicine panels include neurologists, psychiatrists, hospitalists, and emergency physicians.