Background: Telemedicine allows for remote patient evaluation and treatment. Traditionally this model has been applied to rural medical centers with physician shortages. Implementation of a telehospitalist program at well-staffed tertiary care centers may streamline services provided by on-site physicians and improve patient satisfaction.
Purpose: Successfully implement a telehospitalist consultation service at a tertiary referral hospital, identify barriers to utilization, and assess patient perceptions of the telehospitalist service.
Description: Telehospitalist services were provided at a large tertiary care and academic medical center. On-site physicians consulted the service for patients newly admitted from the emergency department. Telehospitalist services included interviewing patients, performing a medication reconciliation, ordering relevant medications and tests, and writing a consult note summarizing their findings and actions. After their assessment, the telehospitalist provided a handoff to an on-site nurse practitioner or physician assistant on the hospitalist service. Two months later, the telehospitalist service expanded to include a smaller tertiary center within the same health system. This facility did not have on-site nurse practitioners or physician assistants. Handoff was given directly to the on-site hospitalist caring for the patient. Utilization rates of the telehospitalist service and patient survey data were obtained for both sites.
Conclusions: Over a period of 9 months, telehospitalist consults placed by the larger tertiary center accounted for only 11% of all consults. This likely stems from the redundancy of services provided by telehospitalists and the on-site staff at the latter facility. At this larger academic center, pharmacists obtain medication histories from every admitted patient, and nurse practitioners or physician assistants are always available for urgent orders or assessments. This model largely differs from the smaller facility where on-site hospitalists are responsible for all orders and medication reconciliations.
Patient satisfaction surveys revealed that the majority of patients assessed by a telehospitalist were comfortable engaging in the consultation. Most patients also felt they received better care, and experienced reduced waiting times as a result of the telehospitalist.
Telehospitalist consultations can complement care provided by on-site physicians at tertiary care facilities and improve patient experience. To reduce redundancy of care, services provided by the telehospitalist must be tailored to the individual needs of a medical center. Effective implementation of telehospitalist services at tertiary care centers can facilitate further studies on patient outcomes and hospital efficiency.