Telemedicine in the Emergency Dept.
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Telemedicine in the Emergency Dept.

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by: Bruce Janiak

by: Bruce Janiak

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Telemedicine in the Emergency Dept. Telemedicine in the Emergency Dept. Presentation Transcript

  • TELEMEDICINE IN THE EMERGENCY DEPARTMENT BRUCE JANIAK, MD,FACEP,FAAP
  •  
  • What is Ethica?
    • 50 skilled nursing centers
    • 4 assisted living centers
    • 5 centers currently with telemedicine
    • 5 additional centers online in March, 2010
  • What is GA Partnership for Telehealth?
  • Telemedicine Sites
    • Eatonton, Ga.
    • Sparta, Ga.
    • Oconee, Ga.
    • Adrian, Ga.
    • Douglas, Ga.
  • The Concept
    • The Emergency Department is open 24/7
    • The challenge is to identify applications that may prevent unnecessary trips to the ED while looking for applications that have a significant financial margin
    • The goal is to eliminate the need for an emergency visit
  • Nursing Homes
    • Approximately 50% of transfers from NH’s to ED’s do NOT result in admission ( Annals of EM)
    • Approximate cost of transfer approx $1000 (transfer)
    • Approximate cost of ED visit $500 (pts discharged back to NH)
  • Empowering Factors
    • Georgia allows billing (if rural)
    • Liability coverage allowed
    • NH staff enthusiastically support
    • ED physicians frustrated with current system
  • Barriers to Usage
    • Cost: $20k per telemedicine unit
    • Primary care doctors apathy
    • Hard to get NH nurses to use (as opposed to old system of calling primary care)
  • Approach to Increase Use of Telemedicine
    • Explain $ advantage
      • Cost of ambulance
      • Cost of ED visit-direct
      • Cost of ED visit-indirect
    • Identify physician advocates
    • Identify nurse “champion” in each facility
  • Cost of Ambulance
    • Charges are based on the type of transport plus the per mile cost
    • The cost reflect one way transport only.
    Gold-Cross Non-Emergent Emergent Per mile cost ALS ( monitor, EKG, IV’s, resuscitative measures) $485.00 $662.00 $11.10 BLS ( IV’s, O2) $404.00 $581.00 $11.00 Capital City Non-Emergent Emergent Per mile cost ALS ( monitor, EKG, IV’s, resuscitative measures $235.60 $373.03 $6.87 BLS ( IV’s, O2) $196.33 $314.13 $6.87
  • Current System
    • Sample size 5 nursing homes
    • 950 transfers over 5 years
    • Cost per ED visit (transportation, hospital and physician) $1500
    • Five year costs 1,425,000
  • New System
    • Capital expense (equipment) $100,000
    • Leasing costs: $24,000
    • Cost of emergency visits (665 x 1500) $997,500
    • Cost of physician charges: $95,000
    • Total cost: $1,216,500
  • Summary for Five Facilities
    • Current system: $1,425,000
    • Telemedicine system: $1,216,500
    • Difference (amount saved): $208,5000
  • Political Barriers
    • Attitudes of primary care docs-competition, financial concern, loss of control-
    • Attitudes of nurses- resistance to change, reluctance to learn new tool, time factor (call pmd vs move pt to telemed suite)
  • Political Support
    • ED docs
    • NH nurses and patients and families