(P49) Telemedicine Coverage Impacts Hospital Transfers in High Acuity Nursing Home

Objective/Aim: Providing direct clinical provider encounters during off hours via telemedicine with the goal of reducing hospital transfers by 15%.

Background: Telemedicine has been described as a promising intervention that can contribute to reducing hospital utilization rates in the form of avoidable hospital transfers.1 Among SNF patients, avoidable hospitalizations occur at a rate of 690 per 1000 patient-years and are often attributed to limited access to physicians and advanced practice providers who resort to telephone consults to manage patients with acute changes in conditions.4-5 Tele-medicine with video capability could assist with the shortage of trained healthcare professionals working in the area of long term care.3

Quality Improvement

Methods: The Silvercrest Center is a large non-profit SNF located in NYC and provides ventilator care with onsite dialysis, enteral/parenteral nutrition and left ventricular assist device management all attributing to medically and behaviorally complex patients with high risk for hospital transfer.
The facility partnered with Sound Physicians for telemedicine coverage on weekdays 5pm-7am including weekends and holidays. The 8 week implementation process included technological set-up, policy development, credentialing, and staff training. Telemedicine encounters were tracked from July 2021 to August 2022 with daily clinical reporting of encounters and monthly operational meetings to discuss metrics, clinical issues and focus areas of improvement.
Process measures included volume of encounters and response time for the provider. Outcome measures included percentage of clinical encounters with treatment in place and pre/post intervention emergency department transfers and hospitalizations captured in the CASPER report.

Results: A total of 1366/1413 telemedicine encounters were treated in place (97%) with an average physician response time of 7 minutes. Common requests for a telemedicine encounter were 1) non emergent changes in clinical condition 2) emergent changes in clinical condition 3) new patient review 4) request for orders or testing.
Comparisons of the facility CASPER report pre telemedicine intervention (time period 1/1/2020 to 12/31/2020) and post intervention (time period 4/1/2021 through 3/31/2022) showed a reduction in risk adjusted hospitalization by 20% for long stay residents (pre 2.06 hospitalizations/1000 resident days vs. post 1.64 hospitalizations/1,000 resident days).
During the same respective period there was a decrease of 30% for emergency department transfers (pre 0.73/1000 resident days vs post 0.51/1000 resident days).
Re-hospitalization rates for short stay residents were reduced by 21% (pre 24% vs post intervention 19%) and ED transfer rates were reduced by 56% (pre 9% vs post 4%).

Conclusions: Telemedicine off hour coverage in a high acuity urban SNF has significant potential to impact hospital transfers for long and short stay residents.