3 . Outcomes for Synchronous , Clinical Video Telehealth ( CVT ) for Chronic Wound Care
Scott Bolhack , MD , Patricia Arocho , RN , BSN , Robin McCollester , MEd , MSN , RN-BC , Cynthia Bakko , RN , BSN , Florence Gores , RN , MPS
Southern Arizona VA Health Care System
Background : The care of chronic wounds is costly to our medical care system . The Southern Arizona Veterans Administration Health Care System ( SAVAHCS ) was awarded a grant to develop a telewound program for the veterans in VISN 18 . After six months of dedicated development , the program went live in November , 2015 .
Methods : Patients were referred into the telewound program from the outlying Community Based Outpatient Clinic ( CBOCs ) to our Telewound Nurse Coordinator who then scheduled patients . Patients were examined with a Wound Certified Physician and Wound Trained Registered Nurse from the base facility in Tucson ; each CBOC had a dedicated , trained nurse who presented the patient , characterized the wound ( measurements , odor , pain , drainage , bandages , etc .), and performed other aspects of the wound care as directed by a certified physician . We collected data from the initiation of the program through the end of March on conditions seen , patients treated , cured , and referred to other specialists .
Results : Through the end of March 2016 , a total of 43 new patients were seen by the team ( s ), for a total of 152 visits . The total healing rate of patients is 35 % from initiation of the program . We have made 11 referrals to specialists during this time period for definitive diagnosis and / or procedures ( dermatology : one skin cancer ; one pyoderma gangrenosum ; podiatry : diabetic ulcerations that required urgent debridement ; plastic surgery : eschar formed in area of prior graft ; general surgery : removal of eschar in wound ; lymphedema : decompression therapy ; burn center : evaluation of potential contractures ). The most common condition is venous insufficiency with ulcerations .
Conclusions : This early start to our Telewound Program at the SAVAHCS proves that complicated wounds can be cared for effectively through telemedicine . The success of the program depends on trained personnel on both sides of the examination .
4 . How Good is that Doc in the Box ? Morgan Boyer , BSN , BS , RN , CNRN Penn State Health , Milton S . Hershey Medical Center
Background : Penn State Health is a telestroke program in a hub for 14 partner hospitals . It has been providing expert stroke neurology consultation using telemedicine for nearly four years . Accuracy of the physician assessment of a potential stroke patient using telemedicine is not widely reviewed . Utilizing real time audio / video encounters and the ability to visualize radiology images , it is expected that the physician would be able to make an accurate consult impression of acute ischemic stroke ( AIS ) and recommend safe treatment options .
Methods : All patients that were consulted and subsequently transferred to the hub were analyzed for variances between consult impression for AIS and a final discharge diagnosis of AIS . In addition the tPA treatment rate for patients consulted using telemedicine with an AIS impression transferred to the hub was compared to the true treatment rate based on discharge diagnosis . Patient outcomes were also reviewed .
Results : In the first year of the telemedicine program , the stroke neurologists accurately diagnosed 79 % of AIS patients transferred to the hub facility . In the second and third year , the accuracy decreased to 76 % ( p value > 0.05 ). The consult volume has greatly increased over the three years without impacting the level of care the stroke neurologists have be able to provide . A high rate of tPA administration using telemedicine was demonstrated ranging from 34 % to 42 % when the transferred population was examined . When the rates are adjusted to recognize the final diagnosis , the rate does not significantly change . Patients that were accepted from a partner hospital post-tPA infusion without a final stoke diagnosis did not experience any adverse sequela related to tPA administration .
Conclusion : The Penn State Health Telestroke Program has demonstrated an average of 77 % accuracy for evaluating the AIS patient and safe thrombolysis treatment recommendations .
5 . Healthcare Technology for High-Risk Homebound Quality Care Julie Bui , PMP MD24 House Call
MD24 is a network of 70 + healthcare providers who bring coordinated medical services to high risk homebound plus complex patients for chronic care management through clinics , traditional house calls , and modern telemedicine . We alleviate the stress of leaving the comfort of home , remove the practical barriers of transportation , eliminate the need to sit in crowded waiting areas and reduce the wait times often associated with facility-based medical visits . Using a technology-driven platform and cost-effective model , we are increasing the appropriate utilization of primary care and specialty services to improve patients ’ overall health , while reducing expensive ER visits , hospitalizations , and readmission . Project MD24 Global Telemedicine Network ( MD24 GTN ) aims to take patients ' values first as the core , and collaborates to build up
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