Jim Roxburgh, RN, MPA Director, Dignity Health Telemedicine Network

Transcription

1 Jim Roxburgh, RN, MPA Director, Dignity Health Telemedicine Network 1

2 Objectives Provide an overview of the DHTN Provide a brief description the DHTN workflows 2

3 Take Home Points All patients deserve high quality and timely care regardless of location All patients deserve access to the most proficient and experienced specialty physicians regardless of location Reliable and consistent access to experienced and proficient specialty physicians drives quality and outcomes Reliable and consistent access to experienced and proficient specialty physicians reduces liability and risk 3

4 DHTN The Facts The Mercy Telehealth Network Founded (2008) Recognized as the Dignity Health Telemedicine Network (2014) 78 End Points (Robots) 52 Specialists 11 different services 39 Partner Sites > 11,743 consults FY Ending June

5 DHTN Services ACUTE Stroke/Neurolog y Mental Health Critical Care Nephrology Pediatrics Newborn Care Cardiology Infectious Disease CLINIC/LTC Geriatrics Neurology Endocrinology Pulmonology Thoracic Surgery Oncology TRANSITIONAL CHF COPD Diabetes Post Surgery Wound Care HOME CHF COPD Diabetes Post Surgery Wound Care 5

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8 PARTNER SITE ACTIVATES INTERNAL ALERT Dignity Health Transfer 1(888) Neonatologist Pediatrician Neurologist Intensivist Geriatrician Psychiatrist Nephrologist RAPID RESPONSE & ASSESSMENT IMAGES DOCUMENTATION REPORTING QUALITY REVIEW 8

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11 Telestroke 11

12 28 Sites 4,319 Consults 2 min Response 12

13 tpa Rate 24% 13

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17 Partner Site Case Reviews Dr. Chaudhary, Telestroke Medical Director Stroke Timeline 17

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21 Dignity Health Telemedicine Network Telestroke Measurements 2015 Dignity Health Telestroke Sites 21 Non Dignity Health Telestroke Sites 7 TOTAL Telestroke Sites 28 TOTAL Volume 4,319 Teleneurologist Response Time (Average) (n = 4,319) 2min % Door to Needle Time < 60 Min (n=170 measured) 63% % Door to Telestroke Activation < 5 Min (n=353 measured) 46% % Recommended to tpa Given < 10 Min (n = 162 measured) 51% 21

22 TeleICU Round & Repond 22

23 Denise Pimintel, RN,MN,MS,CCRN and Jim Roxburgh, RN, MPA at the Catholic Health Association Meeting Annual Meeting June 8, 2015

24 6 ICUs 4 min Response 24

25 ROUNDING Multi Disciplinary Rounds

26 RESPONDING

27 Transfers (One Year Comparison) 2013 Transfers Out from Woodland Memorial Hospital* Total Transfers 213 ED Transfers 142 ICU Transfers 28 *Source: AMAP & Teletracker; transitioned from AMAP to Teletracker software 2014 Transfers Out from Woodland Memorial Hospital** Total Transfers 139 ED Transfers 87 ICU Transfers 25 **Source: Teletracker 27

28 TeleICU Case Study (One Year Comparison) CY 2013 CY 2014 # of ICU Beds 6 6 Severe Sepsis & Shock Mortality 45% 19.4% Ventilator Day ALOS ICU Contribution Margin Increase Decrease Readmission Rate (seen in TeleClinic) NA $868,255 19% 5% (6 mo) 28

29 Telemental Health 29

30 18 Sites 4,684 Consults 3 min Response 30

31 Holds Placed 23% Holds Released 13% 31

32 All patients deserve high quality and timely care REGARDLESS! 32

33 TELEMENTAL HEALTH WORKFLOW ED BEHAVIORAL HEALTH ADMISSION ALL BEHAVIORAL HEALTH PATIENTS Delay

34 TELEMENTAL HEALTH WORKFLOW

35 TELEMENTAL HEALTH WORKFLOW

36 TELEMENTAL HEALTH CHECKLIST Provide the following to the Telepsychiatrist Patient Name Clinical Presentation/Hx Vital Signs/Labs (as appropriate and/or needed) Chief Complaint and/or requested needs of facility (legal eval/meds/etc ) Current Medications and Allergies Behaviors or language observed Collateral information obtained and documented from family or guardian If patient has a 5150 or 1799 be prepared to read it to Tele psychiatrist Be prepared to inform the Telepsychiatrist who will be giving and receiving report 36

37 TELEMENTAL HEALTH CHECKLIST Prior to Consultation- Robot is placed at the foot of the bed or where most appropriate Telepsychiatrist Beams in for consultation TelePsychiatrist will make recommendations in Clinical Apps, and they will be faxed to ED or sent to the EMR (for Cerner Sites only) TelePsychiatrist recommendations will be used by ED Physician to manage disposition Social Work or RN to Coordinate DC DC Home or other facility DC to Psychiatric Facility Crisis Observation and Re-Evaluate 37

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39 Telemental Health FY

40 Geriatric House Call Telemedicine 40

41 HOME 41

42 Recruitment Once Patient agrees to participate, a Dignity Health branded telehealth kit is delivered to the home Easy set up design for non-technical seniors Tech support is provided if needed 42

43 The Telehome Kit Bluetooth BP & Weight 43

44 Clinical Escalation Predetermined criteria for escalation Predetermined clinical contact, when needed 44

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49 Questions? 49