Background: The United States is experiencing a shortage of trained endocrinologists. Endocrinology consultation services were identified as an inaccessible yet necessary service at our large suburban Midwestern community hospital.
Purpose: We set out to pilot a tele-endocrinology service to assist hospitalists in caring for patients with complex endocrine pathologies and monitor outcomes related to this initiative.
Description: To establish the program, we secured internal temporary funding for the pilot. The program initially provided access to a tele-endocrinologist for two hours twice a week on Mondays and Thursdays, for both physician-to-physician chart/discussion consults (interprofessional consults) and virtual tele-medicine consults (tele visits with patient and physician via a tablet). Services were later expanded to seven (7) days a week during daytime hours for a total of four (4) hours per week. The service initially covered inpatients but was expanded to include a six-bed observation unit in the emergency department.The pilot averaged 7 consults per month during our 6-month pilot period, with a range of 4 to 11 consults each month. The most common consultations were for adrenal axis pathologies (n=15, 33%) and diabetes/blood sugar management (n= 15, 33%). The remaining consultations were for Hypo/Hypercalcemia (n=9, 20%), hypo/hyperthyroidism (n=5, 11%), hypertriglyceridemia (n=1, 2%), and hypothermia (n=1, 2%). We surveyed hospitalists to assess their perceptions about the level of support available for caring for patients with complex endocrine diagnoses. Pre-intervention 57% of hospitalists noted that they were not satisfied in response to the question “Endocrinology support improves my patient’s length of stay”. The Likert responses ranged from 1 (not satisfied) to 4 (very satisfied). Post-intervention, satisfaction improved substantially with 54% rating their satisfaction 4 out of 4. In the open comments hospitalists drew attention to their ability to avoid transfers to a higher level of care. Comments included: “Great to have someone to ask questions to and not have to transfer.” “Patient would have required transfer to [the academic medical center] but was able to stay [at our hospital] to receive care.”
Conclusions: We successfully instituted a tele-endocrinology program that enabled and empowered hospitalists to collaboratively provide complex patient care. The ability to care for patients without the need for transfer allows us to care for them closer to their homes and contributes to bed stewardship for our health system. In an era where bed capacity and demand are mismatched, interventions such as ours are important to maintain our ability to care for our communities. We are continuing our work to make this program self-sustaining, increasing consult capacity, and incorporate tele visits into other initiatives, such as improving transitions of care between hospital discharge and clinic follow-up.