As the nation's population continues to age, more patients are becoming reliant on home healthcare services. In response to this demographic change, healthcare organizations are launching telehealth programs to meet the growing demand for remote patient care.
Virtual home care programs have been shown to increase efficiencies, improve outcomes and facilitate more convenient access to care. Clearwater, Fla.-based BayCare Health System leaders discussed how the system's virtual homecare program increased efficiencies during a Nov. 28 webinar hosted by Becker's Hospital Review and sponsored by American Well, the largest video telehealth operator in the U.S.
BayCare Health System presenters included:
- Jeffrey Held, MD, CMO of ambulatory care
- Dianne Hatfield, telehealth project manager
- Laurel Simons, RN, BSN, CWOCN, wound care supervisor
Remote patient care has the potential to fill gaps in primary care. "Only 10 percent of medical residents are going into primary care," Dr. Held said. "The average age of physicians has gone from 45 to 55, which means we don't have enough people to care for the 'grey tsunami.' So, trying to find new, more efficient ways to [provide care] is extremely important."
BayCare started its telemonitor program BayCare Anywhere in 2017 as a part of a project to reduce readmissions for high-risk patients. The health system aimed to improve patients' access to care, experience and outcomes.
The telemonitor equipment consists of a tablet with video system, scale, blood pressure cuff and pulse oximeter. Results are sent through Bluetooth to a centralized telemonitor nurse. The telemonitor program has improved patient engagement, and BayCare Anywhere averages 100 vital readings per patient. "Our goal is to make the patients feel involved, not intimidated," said Ms. Hatfield.
BayCare offers homecare services in 13 counties, with approximately 5,000 visits a month according to BayCare's census. The health system decided to implement a virtual wound care program because only one wound ostomy continence nurse covered nearly 6,500 square miles. Before implementing the program, the wound ostomy continence nurse would drive to and from patients' homes, seeing an average of 10 patients per week.
Through eWound visits, the nurse was able to see 60 patients per week, and patients could make appointments within 24 hours.
With virtual visits, the health system decreased consult wait times by 85 percent and increased consult visits 600 percent. Here are four key components of the BayCare program:
1. Remote technology: Using American Well’s telehealth platform,real-time visits are conducted between the nurse in the patient's home and wound ostomy continence nurse in the office.
A nurse visits a patient in their home, taking down the old dressing and cleaning the wound. The nurse can set up a virtual visit with a wound ostomy continence nurse located anywhere at any time, and the wound ostomy continence nurse can evaluate the wound in real-time and make recommendations to the physician as needed.
2. Standardized documentation and care protocols: The Electronic Wound Care Form allows for standardized documentation in the EMR based on the Bates-Jenson wound score tool. It allows clinicians to retrieve and track wound data by heal rates and wound type.
3. Ongoing wound care education for nurses: "The nurses had to feel that they had buy-in," Ms. Simons said, as they form the backbone of the program.
Some BayCare nurses became wound treatment associates, receiving a certification for RNs offered through the Wound, Ostomy and Continence Nurses Society. A more educated workforce allowed BayCare to fill in service gaps and expand into the eWound visit program.
4. Patient selection criteria: Ms. Simons highlighted selection criteria for patient enrollment as important component of the program. Criteria for enrollment in the program includes the presence of a stage 2 or greater pressure ulcer, daily or twice-daily dressing changes, infected wounds, no improvement or decline in a wound over two weeks and negative pressure wound therapy.
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