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

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 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 3

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 4

DHTN Services ACUTE CLINIC/LTC TRANSITIONAL HOME • Stroke/Neurolog • Geriatrics • CHF • CHF y • Neurology • COPD • COPD • Mental Health • Endocrinology • Diabetes • Diabetes • Critical Care • Pulmonology • Post Surgery • Post Surgery • Nephrology • Thoracic • Wound Care • Wound Care • Pediatrics Surgery • Newborn Care • Oncology • Cardiology • Infectious Disease 5

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PARTNER SITE ACTIVATES INTERNAL ALERT Dignity Health Transfer Center @ 1(888)637-2941 Pediatrician Neonatologist Neurologist Intensivist Geriatrician Psychiatrist Nephrologist RAPID RESPONSE & ASSESSMENT IMAGES DOCUMENTATION QUALITY REVIEW REPORTING 8

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Telestroke 11

28 Sites 4,319 Consults 2 min Response 12

tPA Rate 24% 13

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https://clinicalapps.intouchcustomer.com/login 15

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Dr. Chaudhary, Telestroke Medical Director Partner Site Case Reviews ฀ ฀ ฀ Stroke Timeline 17

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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% 21

TeleICU “Round & Repond” 22

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

6 ICUs 4 min Response 24

ROUNDING Multi Disciplinary Rounds

RESPONDING

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 27

TeleICU Case Study ( One Year Comparison) CY 2013 CY 2014 # of ICU Beds 6 6 Severe Sepsis & Shock 45% 19.4% Mortality Ventilator Day ALOS 2.8 1.4 ICU Contribution Margin NA $868,255 Increase Decrease Readmission 19% 5% (6 mo) Rate (seen in TeleClinic) 28

Telemental Health 29

18 Sites 4,684 Consults 3 min Response 30

Holds Placed 23% Holds Released 13% 31

All patients deserve high quality and timely care REGARDLESS! 32

TELEMENTAL HEALTH WORKFLOW ED ALL BEHAVIORAL BEHAVIORAL HEALTH HEALTH PATIENTS ADMISSION Delay …

TELEMENTAL HEALTH WORKFLOW

TELEMENTAL HEALTH WORKFLOW

TELEMENTAL HEALTH CHECKLIST  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 36

TELEMENTAL HEALTH CHECKLIST  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 only) 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 37

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Telemental Health FY 2015 39

Geriatric House Call Telemedicine 40

HOME 41

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 42

The Telehome Kit Bluetooth BP & Weight 43

Clinical Escalation • Predetermined criteria for escalation • Predetermined clinical contact, when needed 44

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Questions? 49