Background: In a time when rural hospitals across the United States are closing for various reasons and local residents are left with limited access to healthcare, our academic medical center successfully built one of the few new rural facilities in the country and opened it in January 2023. The new hospital is a seventeen bed emergency room and twenty-five bed inpatient facility and primarily serves two counties that rank in the bottom third of our state health outcomes. As a cost-effective and more sustainable alternative to locum staffing, the opening of the hospital utilized a novel inpatient tele-hospitalist staffing model that had been previously validated at a similar sized rural location in the state.
Purpose: To evaluate the functioning of a newly opened rural hospital by looking at key performance metricsUtilizing patient satisfaction scores and internal data we report on key performance indicators based on the first full Fiscal year (July 1 – June 30) of opening. We eliminated the first 6 months of operation as it fell mid fiscal year and the hospital did not have its full array of services and sub-specialties at opening.
Description: The inpatient hospitalist service is managed by onsite APPs with a remote Tele-hospitalist physician overseeing the care of all patients 24/7 and performing virtual video visits on all new patients and any additional patients at the discretion of the APP. From July 1 2023 – June 30 2024 the emergency room saw over 25,000 patients, approximately 68 patients per day, with an average local monthly admission rate of 6% and an additional 6% of visits that resulted in ER transfers. This equated to over 1500 local admissions. The Tele-hospitalist service served as primary doctor of record for the majority of patients admitted at the rural hospital during this period, approximately 84% of inpatient encounters. Direct admits by local providers and the surgeons after elective outpatient procedures accounted for the non tele-health admissions. There were 1183 inpatient discharges and 490 observation discharges. Of those discharges approximately 10% were transfers to higher level of care facilities. The average daily census was 14.3. The avg inpatient length of stay was 3.4 and the Length of stay index for inpatient was 0.85. The mortality index was 0.14 with 30 day readmission rate of 8%. Hospital Consumer Assessment of Providers (HCAP) scores showed >70% patient satisfaction showing the community is embracing the new hospital and its methods.
Conclusions: With the recent closure of two hospitals in the region, the local population was strongly in need of this new medical center and better access to healthcare as evident by the number of emergency room encounters. Since opening in Jan 2023, by utilizing our novel Tele-hospitalist program, in addition to being cost effective compared to alternative staffing, quality metrics have outperformed forecasted models, and patient satisfaction scores shows the community is embracing the program. This serves as a template for future rural hospital viability and expansion to other hospitals is already underway.
