Part of Appalachian Regional Healthcare System, Wautaga Medical Center in rural Boone, North Carolina, already was busy before COVID-19 hit, and leadership knew their current hospitalist staff could not handle the onslaught of patients coming through during the pandemic.
The medical center was looking for a solution that would help provide staffing for the 12-hour day shift. Wautaga already had three inpatient teams and was looking for a telemedicine company to handle a fourth.
The nearest tertiary referral hospital is 90 minutes away, and half of the time helicopters are not able to fly there because of extreme weather. Watauga Medical Center is a Medicare five-star-rated hospital and wanted a telehealth company that could provide the same high quality of care.
On a related note, Cannon Memorial Hospital in Linville, North Carolina, also is part of Appalachian Regional Healthcare System, and it has been using telemedicine vendor Telehealth Solution for three years, for both daytime rounding service, with a physician assistant or nurse practitioner, and full nocturnist coverage.
"At Cannon, we provide both daytime supervision for the ACP on site and MD coverage at nighttime for both cross coverage calls and admissions," said Dr. Lisa Kaufmann, director of hospital medicine at Appalachian Regional Healthcare System. "This has helped reduce overall cost for Watauga staffing while giving access to an MD expertise for patients."
"It is extremely hard to find high-quality locum physicians – our decision to use the telemedicine solution was more about saving patient lives than saving money."
Dr. Lisa Kaufmann, Appalachian Regional Healthcare System
Watauga Medical Center, which is the main hospital, did not use Telehealth Solution's services until it was hit hard with COVID-19. "They began as a PRN service and currently have a telehealth service every day," Kaufmann said.
The proposal was to help with patient volume surges and reduce exposure of clinicians (MDs and ACPs) to COVID-19 infection, ensuring clinical care/coverage for patients is stable and predictable.
"The vendor provided the ability to follow clinical protocols as developed by Watauga clinical leadership," Kaufmann explained. "We needed to work with a company that has a seamless process of direct charting into our patients' EHRs, just as if they were on site. We did not want the hassle of having to learn a whole new system/charting procedure and having to input records manually into our own charting system."
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MEETING THE CHALLENGE
"We looked at a few national companies, but they were very costly and rigid in their requirements," Kaufmann said of the telehealth vendor search. "They would not use our hospital's medical records, and they wanted to send us a specific document that we need to configure on our own to be able to incorporate into our own records.
"It would have taken more time than it was worth, as we were trying to find a company that would work with our hospital seamlessly and quickly, and we couldn't afford to have the downtime, especially during the pandemic."
When Watauga met with Telehealth Solution, everything was simple and streamlined, she added. The company does all of its orders and charting in an existing EHR with no interface needed, she said.
"It improves patient safety as well as workflow on our end," she said. "It is much better than being given a document that needs to be referenced and hunted down in the hospital's electronic files. There was no extra work on our end, which was a true game-changer. It made our decision very easy."
Telehealth Solution works with hospitals in rural towns across the country. With lean staffs, rural hospitals need something that requires minimal IT interface builds, she said.
"They provide custom technology and staff training so that we can access a virtual Telehealth Solution provider whenever we need to," she explained.
"With the push of a button on the nurse-friendly telemedicine cart, a provider appears on the screen to perform a patient evaluation with assistance from the nurse. The virtual physician can remotely view the patient's medical history and charts, order treatment modalities, attend multidisciplinary rounds, have family meetings and discharge our patients."
At Watauga, the success has been with the additional patients that the organization has been able to care for during the pandemic. On average, the medical center has had between 12 and 18 telehealth patient encounters per day since starting clinical coverage for Watauga.
"The vendor provided a daily virtual team staffed by a nurse practitioner or physician's assistant with supervision by a hospitalist who sees every patient on the service," Kaufmann explained. "The telehealth cart includes a high-resolution camera and an electronic stethoscope, which permits a much better physical examination of the patient than can be done with tablets.
"What telehealth did for us was much more important than cost savings of having to hire an extra hospitalist. They made it possible to staff Cannon Memorial and keep it open to medical patients. Preserving a critical access hospital for the people who need care in this rural area is a very big deal."
In the same way, at Watauga Medical Center staff had no way to quickly find additional on-site physicians in this rural area. Telehealth is helping to make it possible to take care of what soon will be twice the medical center's normal number of patients.
"The point is not only that it is more cost-efficient to hire telehealth than locum physicians," Kaufmann said. "Also, it is extremely hard to find high-quality locum physicians – our decision to use the telemedicine solution was more about saving patient lives than saving money. There is no place in Western North Carolina during the current surge that is able to accept transfers."