venience with subthemes of i. “less travel time and mileage”
with references to significant travel reduction (n= 36), ii.
“prompt care” (n=7), iii. “easy-to-use” (n= 6); 3) Confidence
with subthemes of i. “complete, comprehensive care” (n= 13),
ii. “highly qualified and professional service” (n= 9); and 4)
Connection with subthemes i. “my cardiology team” (n= 13),
ii. “very personable” (n= 10), and iii. “things were clearly
explained to me” (n= 9). Negative commentary was not
provided.
Conclusions: Veterans using telecardiology found the service
substantially satisfactory. The most commonly reported bene-
fit was that telecardiology was highly convenient, saving sig-
nificant travel time while providing an easy-to-use and
prompt service. Confidence in the cardiology medical service
accuracy and treatment was expressed. Telecardiology was
perceived as professional, personal, and educationally in-
formative and Veterans appreciated seeing consistent provid-
er teams. Overall, this research provides a conceptual founda-
tion for future VA telecardiology patient satisfaction research.
16. General Surgery Consults Via
Telemedicine
Katie L. George, DNP, MSN, ACNP, RN, CCRN
University Physicians Group,
University of Virginia Health System
Background: There is a lack of surgical care, especially for
complex cases, in remote areas. Surgical candidacy can often
be determined through complete history taking in combina-
tion with imaging, thus avoiding the need for a face to face
encounter. Not all patients are surgical candidates, which can
be frustrating for patients to hear after extended travel for
surgical evaluation. Additionally, telemedicine has repeatedly
resulted in high patient satisfaction ratings.
Methods: A Telemedicine Surgery Consult pilot protocol was
created to offer a telemedicine visit to all patients who lived
greater than 60 miles away. The patient was evaluated via
telemedicine by either an attending surgeon or the surgery
nurse practitioner. To reduce the risk of surgical complica-
tions, relative contraindications to surgery included BMI > 35,
active smoking, and/or had a HBA1C > 8. In these cases, sur-
gery was deferred and resources were provided to help the
patient improve his/her health prior to surgery. In mid-2017
provider access to telemedicine was increased through iPad
distribution and installation of telemedicine equipment within
the surgery clinic.
Results: From January 2015 to June 2017 twenty-five general
surgery consult patients were seen. A total of 6,174 miles
driven were saved. A significant number of patients were una-
ble to enroll, as a large telemedicine satellite station was tem-
porarily non-operational.
43 | Page
Conclusions: This pilot protocol increased access to care for
general surgery patients, and anecdotally increased other
surgeons’ acceptance of telemedicine. The program continues
to expand as additional surgeons, including other surgical
specialties, now have easy access to telemedicine capabilities.
We expect our telemedicine patient encounters to increase
exponentially as provider comfort with the technology in-
creases, additional telemedicine satellite locations are estab-
lished, and follow-up visits are transitioned to telemedicine.
17. CEP On Duty ® Telepsychiatry
Herbert Harman, MD, Richard Newell, MD, Emily Rosendahl,
Lauren Sweeney, Tami Longo, Lindsay Kriger, Andrew Smith
CEP America
Background: The U.S. is currently facing a mental health cov-
erage crisis; nowhere is this crisis more pronounced than in
hospital Emergency Departments (EDs) where patients regu-
larly board for hours or even days before being seen by the
appropriate level of care. Often the patient is transferred to
an inpatient unit in another facility. Telepsychiatry is a meth-
od to increase timely access to care, and promote better out-
comes at an affordable price.
Methods: CEP America’s Telepsychiatry program provides
24/7 access to board-certified psychiatrists. When a patient
comes to the hospital with a mental health crisis, a consult
can be ordered on-demand by the ED physician. An experi-
enced emergency-trained psychiatrist will then review patient
records, and connect with the patient via high-quality, HIPAA
secure video. Thorough documentation including medical
history, diagnosis, disposition recommendations and plan/
care instructions are made available to the referring physi-
cian.
Results: From January to May 2017, over 250 patients were
seen via the On Duty Telepsychiatry platform from three
different hospital locations. Average wait time to see a psychi-
atrist is less than 1 hour, and consults last an average of 30
minutes. Only 18% of patients seen via On Duty Telepsychia-
try were recommended for inpatient psychiatric care, while
42% were recommended for discharge – much higher than
the national average. For those seen while on an involuntary
hold, 57% of holds were recommended to be dropped.
Conclusions: CEP’s Telepsychiatry program has resulted in
faster than average treatment and disposition of mental
health patients. As time goes on, we expect this program will
show improvement in patient experience, patient throughput,
and cost savings.