Telemedicine in the Emergency Dept.

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

Telemedicine in the Emergency Dept.

by Lloyd Sirmons on Mar 14, 2011

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Telemedicine in the Emergency Dept. — Presentation Transcript