rate after discharge in 2010 was 20 %. One of the greatest challenges in the US health care system is to provide quality care in a population which does not have access to specialty physicians due to factors like socioeconomic conditions and geographic limitations .
Methods : Percentage analysis was done from the total active population of high risk homebound patients including but not limited to patients in pain management , behavioral health , and palliative care patients ; with a focus on reduction of hospital readmissions and patient outcomes . Data were all collected from 2015 from March 2015 to July 2017 from the Bridgeway Health Plan in Maricopa County .
Results : There were 224 total patients . 52 of the patients were TCM qualified . Data showed that the readmission rate was 9.6 % on a 30-day readmission rate .
Conclusions : The study was made to seek the benefits of house calls services in combination with Telemedicine collaborating with Accountable Care Organizations . Not only were the readmissions reduced , telemedicine in Homebound patients would allow easy access to health care , especially in rural areas , and it will also improve access to a network of specialists . It is predicted that hospital readmissions will be further reduced by 5 % in 1 year if done with the combination of telemedicine and traditional care in the United States in the 3 rd quarter of 2017 .
33 . Impact of Wound TeleHealth Program on Homecare Operations & Quality
Katherine Repko , MS , BSN , RM , Brenda Freymiller , MS , Becky Greenwood , RN , Mariko Nielson , MBA
Intermountain Healthcare
Background : Homecare ( HC ) nurses need wound care provider support for patients with complex wounds to facilitate assessment and recommendations that will promote healing process and decrease cost of care . Historically , the HC Wound Specialist Nurse would collaborate with HC nurses on complex , non-progressing wound patients through email and phone calls or , in cases where the patient lived in the Salt Lake City or Provo areas , would schedule and travel to the patient ’ s home for a shared visit with the assigned HC nurse . These visits would result in a request for orders from the PCP for a treatment change or a referral to a wound clinic . To receive homecare services , a patient must be home-bound and for some patients , arranging travel to a wound clinic for specialized care is very challenging . Some patients decline wound clinic services because of the cost and difficulty of transporting to a brick and mortar clinic site .
Methods : In January 2017 , the Wound and Homecare teams began a pilot to provide TeleHealth consultations in the patient ’ s home using Skype for Business . Patients targeted had non-progressing wounds or wounds requiring daily dressing changes , and significant challenges in transporting to a wound clinic . Once identified , treatment options were explained to the patient and an order for Wound TeleHealth was obtained . The HC nurse obtained patient consent , facilitated scheduling the consult , and updated the treatment plan as directed by the TeleHealth Provider . The HC Wound Specialist Nurse also started utilizing the Skype for Business application to perform shared visits in real time .
Results : Homecare Wound Specialist in-person shared visit costs and frequency were reduced by 89 % and 66 % respectively . Visits previously limited by geographic location have now been expanded to support all locations within Intermountain Homecare .
Conclusions : TeleHealth effectively brings needed wound care expertise to HC patients with complex wounds .
34 . The e-Mentor Program : A Post- Orientation Support Tool for New ICU RNs
Sally Richter MN , RN , CCRN-E , Jennifer Fiegel , Erin Saunders Banner Health
Background : For new to service ( NTS ) and new graduate ( NG ) registered nurses ( RNs ) hired into critical care , the postorientation time frame for these RNs and their peers can be a stressful time necessitating extra resources to ensure adequate development and retention . Based on a program by Brindise et . al . ( 2015 ), a pilot program pairing experienced Tele-ICU RNs with post-orientation NTS and NG bedside RNs in two intensive care units ( ICUs ) was developed to provide support and facilitate their transition to competency .
Methods : The e-Mentor program was piloted in a rural hospital setting and in an urban hospital setting . The goals were to provide support ; improve confidence ; and improve critical thinking in the post-orientation bedside RN ( participants ). A structured program was developed for e-Mentors and participants . E-Mentors evaluated the participant each shift . Meetings were held with participant and e-Mentors every 30 days to evaluate progress . Participants and e-Mentors also completed program evaluations .
Results : The e-Mentor program pilot consisted of 2 RNs with NTS experience in the rural setting and 7 RNs in the NTS / NG experience level in the urban setting . The e-Mentor evaluations demonstrate participants ’ improved time management and critical thinking skills with all reaching the top level of “ functions independently “ at program end . Participant comments reveal feelings of supportiveness and greater confidence . The most positive results / comments were seen with the NG RNs .
Conclusions : The e-Mentor program developed supportive relationships between experienced Tele-ICU RNs and postorientation ICU RNs . This mentorship helped to foster confidence and critical thinking . Additional program benefits include increased future utilization of Tele-ICU RNs and improved bedside RN retention . Further study is warranted .
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