It’s easy to forget this now, but when COVID-19 first swept its way into disrupting and forever changing American life, the city that felt the largest initial impact was New York.
And as Vice President and Medical Director of NewYork-Presbyterian’s Silvercrest Center for Nursing and Rehabilitation in Queens, New York, Dr. Lucan Rodrigues was among the earliest health care professionals to chart a path to the future.
“When we started entertaining the idea of telemedicine, we were a few months into the pandemic,” Rodrigues says. “Having a group with knowledge of the post-acute space was important in the rapidly expanding field of telehealth.”
What Rodrigues and his colleagues understood was that in a health care landscape increasingly defined by finding the right mix between in-person meetings and video communication, skilled nursing facilities and other post-acute providers needed to find the right telehealth partnership and strategy that would help them minimize hospital transfers for their residents.
Silvercrest Center found Sound Physicians, a telemedicine leader that connects hospitalists and SNFs. Sound set a goal of reducing Silvercrest’s hospital transfers by 15%, by providing direct access to virtual physicians during off hours via telemedicine.
During a 14-month pilot program from July 2021 to August 2022, Silvercrest met that goal and then some:
- Patients transferred to a hospital: 47
- Patients treated in place: 1,366
“Sound Physicians is a very reputable group with a national presence,” Rodrigues says. “We did entertain other telemedicine groups, but after talking with Sound and their implementation team, it sounded like they were very well-versed in what they were doing, and it instilled confidence in us to partner with them.”
What telemedicine brings to SNF
At a time of staffing shortages and increased concerns among patients about infection control, telemedicine continues to prove itself as a promising intervention that can contribute to reducing hospital utilization rates in the form of avoidable hospital transfers.
Among SNF patients, avoidable hospitalizations occur at a rate of 690 per 1000 patient-years and are often attributed to limited access to physicians and advanced practice providers who resort to telephone consults to manage patients with acute changes in conditions.
Telemedicine with video capability can assist with the shortage of trained health care professionals working in the area of long term-care.
“When we first started talking with Sound, one of our main concerns was how we would roll out the program in a practical way,” Rodrigues says. “At times it sounded complex, but the onboarding team was able to easily delineate their workflow and meaningfully respond to pertinent questions. They had very well-crafted education and staff training materials, and we were quite impressed by their detailed implementation plan.”
Inside the numbers: how telemedicine keeps SNF residents out of the hospital
For its pilot, Silvercrest partnered with Sound for overnight coverage, 5 p.m. to 7 a.m., as well as weekends and holidays. The implementation process included technological set-up, policy development, credentialing and staff training. Telemedicine encounters were tracked with daily clinical reporting of encounters and monthly operational meetings to discuss metrics, clinical issues and focus areas of improvement.
“The rollout was key,” Rodrigues says. “The Sound team offered a lot of support and strategies on troubleshooting clinical and non-clinical issues that arose early in the program.”
Sound measured the success of the process with two metrics:
- Volume of encounters
- Response time for the provider
Other important outcome measures included:
- Percentage of clinical encounters with treatment in place
- Pre- and post-intervention E.D. transfers and hospitalizations captured in the CASPER report
“The video platform during a virtual encounter allows for a thorough clinical exchange between patient, physician and nursing,” Rodrigues says. “That’s largely how we achieved our high level of success.”
Among the most exciting figures for Rodrigues and his team: both long-stay and short-stay hospitalizations and ED transfers all declined significantly for a given period of time during the proof-of-concept phase and first round of their Performance Improvement PDSA (Plan, Do, Study, Act) cycle:
– Long-stay hospitalization: 20% decrease
– Long-stay ED transfers: 30% decrease
– Short-stay hospitalizations: 21% decrease
– Short-stay ED transfers: 56% decrease
One significant takeaway discussed during the annual AMDA Conference poster session in Tampa, Florida, earlier in the year was that telemedicine off-hour coverage in a high-acuity urban SNF does have significant potential to impact hospital transfers for long and short stay residents. Dr. Rodrigues continues to be hopeful on the role of telemedicine in the health care sector. “We plan to continue our mission of delivering high-quality care without compromise,” he says.
This article is sponsored by Sound Physicians, and is adapted from a new report. To learn more, visit soundtelemedicine.com.
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