1 Objectives Provide an overview of the DHTN Provide a brief - - PowerPoint PPT Presentation

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1 Objectives Provide an overview of the DHTN Provide a brief - - PowerPoint PPT Presentation

Sep 16, 2023 103 likes •605 views

Jim Roxburgh, RN, MPA Director, Dignity Health Telemedicine Network 1 Objectives Provide an overview of the DHTN Provide a brief description the DHTN workflows 2 Take Home Points All patients deserve high quality and timely care

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Jim Roxburgh, RN, MPA

Director, Dignity Health Telemedicine Network

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Objectives

  • Provide an overview of the

DHTN

  • Provide a brief description the

DHTN workflows

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Take Home Points

  • All patients deserve high quality and timely

care regardless of location

  • All patients deserve access to the most

proficient and experienced specialty physicians regardless of location

  • Reliable and consistent access to experienced

and proficient specialty physicians drives quality and outcomes

  • Reliable and consistent access to experienced

and proficient specialty physicians reduces liability and risk

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DHTN The Facts…

 The Mercy Telehealth Network Founded (2008)  Recognized as the Dignity Health Telemedicine Network (2014)  78 End Points (Robots)  52 Specialists  11 different services  39 Partner Sites  > 11,743 consults FY Ending June 2015

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DHTN Services

ACUTE

  • Stroke/Neurolog

y

  • Mental Health
  • Critical Care
  • Nephrology
  • Pediatrics
  • Newborn Care
  • Cardiology
  • Infectious

Disease

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CLINIC/LTC

  • Geriatrics
  • Neurology
  • Endocrinology
  • Pulmonology
  • Thoracic

Surgery

  • Oncology

TRANSITIONAL

  • CHF
  • COPD
  • Diabetes
  • Post Surgery
  • Wound Care

HOME

  • CHF
  • COPD
  • Diabetes
  • Post Surgery
  • Wound Care
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2015

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8 PARTNER SITE ACTIVATES INTERNAL ALERT Dignity Health Transfer Center @

1(888)637-2941 Psychiatrist Intensivist Neurologist Nephrologist Neonatologist Pediatrician Geriatrician

RAPID RESPONSE & ASSESSMENT DOCUMENTATION REPORTING IMAGES QUALITY REVIEW

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Telestroke

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28 Sites 4,319 Consults 2 min Response

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tPA Rate

24%

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https://clinicalapps.intouchcustomer.com/login

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  • Dr. Chaudhary,

Telestroke Medical Director

฀ ฀ ฀

Partner Site Case Reviews

Stroke Timeline

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Dignity Health Telemedicine Network Telestroke

Measurements 2015 Dignity Health Telestroke Sites 21 Non Dignity Health Telestroke Sites 7 TOTAL Telestroke Sites 28 TOTAL Volume 4,319 Teleneurologist Response Time (Average) (n = 4,319) 2min % Door to Needle Time < 60 Min (n=170 measured) 63% % Door to Telestroke Activation < 5 Min (n=353 measured) 46% % Recommended to tPA Given < 10 Min (n = 162 measured) 51%

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TeleICU

“Round & Repond”

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Denise Pimintel, RN,MN,MS,CCRN and Jim Roxburgh, RN, MPA at the Catholic Health Association Meeting Annual Meeting June 8, 2015

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6 ICUs 4 min Response

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ROUNDING Multi Disciplinary Rounds

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RESPONDING

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Transfers (One Year Comparison)

2013 Transfers Out from Woodland Memorial Hospital*

  • Total Transfers 213

– ED Transfers 142 – ICU Transfers 28

*Source: AMAP & Teletracker; transitioned from AMAP to Teletracker software

2014 Transfers Out from Woodland Memorial Hospital**

  • Total Transfers 139

–ED Transfers 87  –ICU Transfers 25

**Source: Teletracker

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TeleICU Case Study (One Year Comparison)

CY 2013 CY 2014 # of ICU Beds 6 6 Severe Sepsis & Shock Mortality 45% 19.4% Ventilator Day ALOS 2.8 1.4 ICU Contribution Margin Increase NA $868,255 Decrease Readmission Rate (seen in TeleClinic) 19% 5% (6 mo)

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Telemental Health

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18 Sites 4,684 Consults 3 min Response

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Holds Placed 23% Holds Released 13%

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All patients deserve high quality and timely care

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REGARDLESS!

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TELEMENTAL HEALTH WORKFLOW

ALL BEHAVIORAL HEALTH PATIENTS Delay…

ED BEHAVIORAL HEALTH ADMISSION

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TELEMENTAL HEALTH WORKFLOW

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TELEMENTAL HEALTH WORKFLOW

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 Provide the following to the Telepsychiatrist Patient Name Clinical Presentation/Hx Vital Signs/Labs (as appropriate and/or needed) Chief Complaint and/or requested needs of facility (legal eval/meds/etc…) Current Medications and Allergies Behaviors or language observed Collateral information obtained and documented from family or guardian If patient has a 5150 or 1799 be prepared to read it to Tele psychiatrist Be prepared to inform the Telepsychiatrist who will be giving and receiving report

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TELEMENTAL HEALTH CHECKLIST

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 Prior to Consultation- Robot is placed at the foot of the bed or where most appropriate  Telepsychiatrist Beams in for consultation  TelePsychiatrist will make recommendations in Clinical Apps, and they will be faxed to ED or sent to the EMR (for Cerner Sites

  • nly)

TelePsychiatrist recommendations will be used by ED Physician to manage disposition Social Work or RN to Coordinate DC DC Home or other facility DC to Psychiatric Facility Crisis Observation and Re-Evaluate

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TELEMENTAL HEALTH CHECKLIST

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Telemental Health FY 2015

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Geriatric House Call Telemedicine

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HOME

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Recruitment

  • Once Patient agrees to participate, a Dignity Health branded

telehealth kit is delivered to the home

  • Easy set up design for non-technical seniors

– Tech support is provided if needed

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The Telehome Kit

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Bluetooth BP & Weight

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Clinical Escalation

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  • Predetermined criteria for escalation
  • Predetermined clinical contact,

when needed

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Questions?