Telemedicine provides a variety of services for hospitals. These services fall into two categories:
- Hospitalist Services. Telemedicine provides hospitalist coverage to help fill staffing gaps, cover nighttime hours and keep daytime physicians from having to take calls during the night.
- Specialty Services. Telemedicine can also provide specialized services such as neurology, cardiology and ICU care when a hospital wants to offer new services to its community but doesn’t have the local resources to provide them on its own.
Relieving hospital stress in four key areas
Night coverage. Quality night coverage can be a headache for any hospital. In small facilities, staff physicians might have to rotate working at night or be on call to answer questions from night nurses when patients have problems. It can quickly lead to burnout, especially today when young physicians place a greater premium on work/life balance than their predecessors. Telemedicine can solve the problem.
For example, a 25-bed critical access facility in rural Oregon replaced its nocturnist hospitalist staff with an Eagle telemedicine team and onsite nursing staff. Collaborating with 24/7 ER physicians, the telenocturnists handle an average of 50 admissions a month, which matches the admission rate when nocturnists were handling night coverage.
NP/PA backup. Despite the physician shortage, the supply of nurse practitioners (NPs) and physician assistants (PAs) is growing. Studies show there were about 155,000 practicing NPs in the U.S. in 2010. That number will grow by 57 percent to 244,000 in 2025. The PA supply will grow by about 73 percent during the same period, from 74,000 to 128,000.
Smart hospital leaders are already taking advantage of the more plentiful supply of NPs and PAs. While they still employee hospitalists to lead clinical teams, they are rounding out their staff with NPs and PAs who perform the same functions as physicians; they conduct daily rounds with patients, complete admissions from the Emergency Department (ED), diagnose patients and prescribe treatment and medication. Through telemedicine, a cadre of hospitalists are available by phone, text and two-way video conferencing to advise the local clinical team, suggest approaches to patient care and validate decisions the NPs and PAs make.
Surge protection. Hospitals have tried many approaches over the years to manage surges—those periods such as flu season when ED traffic and admissions spike. A “jeopardy” system that keeps an unscheduled doctor on call to handle periodic ED admissions has its drawbacks. Pay rates for jeopardy doctors are usually higher than average hospitalist compensation and since staff hospitalists often serve as the jeopardy doctor on their days off, few doctors want to be the “weak link” who calls to interrupt those valuable days of downtime.
Telemedicine solves the problem for both rural hospitals that have difficulty finding qualified staff and for metropolitan hospitals that are trying to keep staff on an even keel regardless of surges in patient volume.
Cross-cover calls. The same telemedicine teams that provide surge protection can also cover cross-cover calls, giving relief to night hospitalists who may already be overwhelmed with admissions, yet their phones are ringing constantly with requests to respond to patient issues on the floor. With telecross-coverage, telehospitalists can remove the burden of floor calls and consultations from onsite ED nocturnists, and are available to help with ED admissions during peak periods.
Expert care, anywhere
As the supply of primary care physicians continues to shrink, so will the supply of specialists. According to an Association of American Medical College’s study, specialties like emergency medicine, anesthesiology, radiology, neurology, and psychiatry, among others—will face a shortage of between 18,600 and 31,800 physicians by 2030.
Specialists in cardiology, nephrology and other areas might be on call with a local hospital, but without backup for nights, weekends, holidays, or vacations. Telemedicine is helping fill the gaps. “Telespecialists” share coverage with local providers—individuals and small practices alike—to help ease the demands on them. For example, a community hospital might have a local cardiologist on call 15 days a month, and a telecardiology team on call the other 15 days of the month.
Specialty services can also help a hospital respond to changing healthcare needs in its community, offer new services to patients, and avoid having to transfer patients to larger hospitals in metropolitan areas to get the necessary care.
Specialty services can include:
- Teleneurology—For quick diagnosis and response to patients with symptoms of stroke or other acute neurological emergency
- Telecardiology—For diagnosis and treatment of heart disease, including the transmission of clinical data and electrocardiograms
- Telepsychiatry—For delivery of behavioral health assessment and care, supported by the American Psychiatric Association as a valued component of a mental health delivery system
- Tele-ICU—For monitoring and treatment of ICU patients by a critical care team of intensivists and critical care nurses in an effort to reduce a patient’s length of stay in the ICU
- Tele-ID—For diagnosis and treatment of infectious diseases, manage infections and monitor administration of antibiotics
- Telenephrology—For patients needing inpatient consults, inpatient dialysis, and follow-up visits
- Telepulmonology—For patients with obstructive pulmonary diseases, in which remote pulmonology specialists review spirograms and other relevant clinical information to provide accurate diagnoses and treatment
- Teleoncology—For the provision of critical services such as hematology and oncology consultations, genetic counseling, palliative care assistance, and cancer treatment reviews