Dr. Erkan Hassan

Monthly Writings

Evaluations and reviews of the latest in the field.

Telemedicine Relevance in Skilled Nursing Facilities

SUMMARY:

  • Most skilled nursing home patients have complex healthcare needs

  • Organizational factors, lack of confident decision making, and workload issues are all factors adversely impacting deteriorating health issue evaluations

  • Telemedicine may provide a possible solution to ease accessibility to provide care needed

COMMON PAIN POINTS

  • Limited practitioners present during acute situations

  • Staff uncertainty of roles and responsibilities

  • Excessive transfers with sudden health situations

REVIEW

  • The quality of care in skilled nursing facilities (SNF) is often described as inadequate.

  • It is estimated approximately 35% of SNF hospitalizations can be prevented and treated in the SNF.

  • Most common SNF hospitalizations are diseases of:

    • Central & Peripheral nervous system 18%

    • Respiratory system: 15%

    • Digestive Track: 15%

  • Telemedicine is one possible solution to:

    • Avoid hospitalizations

    • Mitigate issues within the SNF environment.

    • Easy accessibility

    • Rapid consultation to address care needs

  • Most studies report a reduction in emergency department (ED) visits and/or hospitalization rates

    • Current studies suffer from varying methodologic designs making direct comparisons difficult.  These include:

      • Use of specialized nursing staff

      • Telemedicine consults offered on different days of the week

      • Telemedicine consults offered during evening hours

  • The major challenges identified in preventing optimal SNF telemedicine implementation consist of:

    • Fluctuations in day/night staffing levels

    • Staff uncertainties in exchanges with other care providers

    • Insecurity with sudden health situations

    • Limited presence of general practitioners, causing delays in standard treatment procedures

    • Ambiguous roles and responsibilities during acute health issues

    • Lapse in communication

    • Quality management is needed in a standardize approach

  • Integrated care will deliver seamless healthcare in SNF settings. 

  • However, this remains a goal at the present time

  • Telemedicine in the assessment and management of SNF patients have been shown to decrease ED visits, hospitalizations and costs of care. However, are also not broadly employed.

  • Structural, organizational, heavy workloads, unclear responsibilities, and lack of confidence are major challenges, particularly at night.

  • By taking a comprehensive approach to address clinical adoption, workforce optimization, and technology integration, telemedicine programs can help improve the outcome of these patients.

CONCLUSIONS:

  • Improved outcome of SNF patients will involve the combination of telemedicine, interprofessional training and education, and collaboration.

  • The implementation of these approaches are necessary to improve healthcare practices within the SNF population

Erkan Hassan