When it comes to post-acute care, skilled nursing facilities that partner with telemedicine teams have found greater success in managing patients, improving quality, and avoiding hospital readmissions.
Why? Telemedicine physicians fill the gaps. They show up when others can’t or won’t. And they provide essential consultation, care, and guidance around how—and where—to treat the patient.
Collaboration Is Key
While the onsite clinical team at a skilled nursing facility (SNF) manages patients day to day, there are times when the medical director has gone home for the night, or the attending physicians aren’t available during evenings and weekends. These after-hours are the most fraught for everyone, as there are fewer people available, and decisions around more urgent situations need to be made quickly. That decision can mean the difference between a patient spending the next day or two in the hospital—or being able to stay in the facility.
As one of our partners, the medical director of a downstate New York SNF, said, “When a nurse calls a doctor, wakes them up in the middle of the night, and describes shortness of breath and a fever, the doctor sends them to the [emergency department]. I can’t fault them for that, but I hate transferring people out to the hospital.”
Doing so is disruptive to the patient and their family and increases the risks of further complications. Partnering with a telemedicine team means reaching a physician who isn’t surprised by that call but rather is on shift expecting it. As such, that telemedicine physician can invest the time and care needed to evaluate the patient and collaborate with the onsite team to treat them in place, if clinically appropriate, all while providing necessary support so the daytime team can rest.
Within hundreds of facilities around the country, we’ve seen an average 15 percent reduction in 30-day all-cause readmissions.
As the medical director noted of their partnership with Sound, “It’s a game-changer. We provide phenomenal care at night vs. the knee-jerk reactions that happen when you wake a physician up. We have better quality—no two ways about it.”
Telemedicine Eases Transitions of Care
Sound telemedicine is designed to be available for urgent, on-demand, clinical escalations that result in a best-in-class, treatment-in-place rate for our patients and the communities we serve. But that’s only part of our clinical story.
It’s well known that transitions of care are fraught with potential complications for patients. We strive to mitigate those barriers with our transfer management program, helping manage transfers to and from the SNF.
For patients who aren’t appropriate to treat in place, we apply our emergency department (ED) management protocol. Our virtual clinicians call the ED and speak to the physicians there about the clinical indications for an ED transfer. This helps focus the workup on what’s relevant to the patient’s current situation and results in another opportunity to avoid unnecessary readmission. Thirty-nine percent of the time we manage the transfer, we’re able to have our patients return to the SNF from the ED without inpatient admission.
When patients are admitted to the SNF after hours or weekends—either from a late hospital discharge or ED visit—our virtual clinicians will see them on video and “tuck them in” at the SNF. We ensure they have all appropriate medications and orders until their attending physician can take a full history in person.
Making It Easier
We know clinicians and skilled nursing facility staff have plenty to manage already. When partnering with a telemedicine team, you want someone who can seamlessly integrate into your existing clinical workflow.
With the workload already facing SNF teams, no one has time for a long, drawn-out ramp-up. We make it easy to engage with our telemedicine team whether a patient is in the care of a veteran nurse who’s been with the SNF for years or someone brand new.
On our end, we have access to the patient’s full electronic medical record (EMR) and leave our notes directly in the record. We also offer a summary of all facility encounters via email and share our reports in the EMR.
Additionally, we offer bite-sized training modules around topics such as how to use our service and how to prepare for a consult. These modules can be completed by SNF team members when it’s convenient for them.
Things Can Only Get Better
In case after case, we see the same results when SNFs partner with telemedicine teams: patients experience fewer transfers and fewer long- and short-term hospital stays. The benefits to patients cannot be overstated: caring for them in place is much less disruptive and improves their morale and well-being as well as the emotional well-being of family and friends who engage with the patient.
Being able to safely treat the patient in place also helps the facility avoid penalties associated with unnecessary transfers as well as strengthens the efficiency, confidence, and morale of its onsite team.
Here are some of the benefits we’ve seen, and continue to see:
- Video consultations allow for better care after hours.
- Nurses rest easier knowing they can always reach a physician who’s ready to help.
- Escalations and falls are increasingly treated in place.
- Hospital transfers and readmissions drop significantly.
Telehealth is here to stay, as it continues to offer benefits to patients and clinicians alike. With sicker and frailer people to treat, telemedicine helps close care gaps at SNFs and ensures that patients get what they need, when they need it most.
Brian Carpenter, MD, is the chief medical officer for telemedicine at Sound Physicians.