Adam T Koch, Rachel L Keuseman, Riddhi Parikh, Sean R Legler, Shant Ayanian, Renu Bhargavi Boyapati, Karen M Fischer, Donna K Lawson, Sagar B Dugani, M Caroline Burton, Sandeep R Pagali
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引用次数: 0
Abstract
Introduction: Optimal hospital bed utilization requires innovative patient care models. We studied a novel hospitalist model utilizing telemedicine to facilitate collaboration with affiliated emergency departments (EDs) and support medical triage and care of ED patients with high likelihood of hospital admission.
Methods: Telehospitalists based at a tertiary care facility collaborated with four community EDs in the same healthcare network between January 1, 2022, and April 30, 2023. Telehospitalists supported ED clinicians in medical care decisions and facilitated patient disposition. Emergency department length of stay (LOS) and disposition were evaluated, as were hospital LOS, 30-day readmission, and in-hospital mortality. For patients discharged from the ED, 7-day ED readmission and subsequent hospitalization were evaluated.
Results: Telehospitalists discussed 550 "admit-likely" patients with ED clinicians: 105 patients (19.1%) discharged from the ED and avoided admission; 322 patients (58.5%) were admitted to local or nearby community hospitals; 123 patients (22.4%) transferred to the tertiary care facility. Emergency department LOS differed significantly among disposition groups, including patients discharged home (10.2 h), admitted to local hospitals (12.6 h), and transferred to tertiary care hospitalist services (14.9 h; p < 0.001). Hospital LOS and in-hospital mortality were not significantly different among disposition groups. Patients admitted locally had lower 30-day readmission compared to those transferred to tertiary care facility (odds ratio = 0.59 [0.36, 0.99], p = 0.048).
Discussion: Telehospitalists as triage clinicians is an innovative approach to support local ED clinicians and patients. Telehospitalists optimized hospital bed utilization and healthcare system resources by facilitating safe discharges to home and expediting tertiary care transfers when necessary.
期刊介绍：
Journal of Telemedicine and Telecare provides excellent peer reviewed coverage of developments in telemedicine and e-health and is now widely recognised as the leading journal in its field. Contributions from around the world provide a unique perspective on how different countries and health systems are using new technology in health care. Sections within the journal include technology updates, editorials, original articles, research tutorials, educational material, review articles and reports from various telemedicine organisations. A subscription to this journal will help you to stay up-to-date in this fast moving and growing area of medicine.
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