telemedicine in the emergency department bruce janiak, md,facep,faap
Post on 27-Dec-2015
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What is Ethica?
• 50 skilled nursing centers• 4 assisted living centers• 5 centers currently with telemedicine• 5 additional centers online in March, 2010
The Concept
• The Emergency Department is open 24/7• The challenge is to identify applications that
may prevent unnecessary trips to the ED while looking for applications that have a significant financial margin
• The goal is to eliminate the need for an emergency visit
Nursing Homes
• Approximately 50% of transfers from NH’s to ED’s do NOT result in admission (Annals of EM)
• Approximate cost of transfer approx $1000 (transfer)
• Approximate cost of ED visit $500 (pts discharged back to NH)
Empowering Factors• Georgia allows billing (if rural)• Liability coverage allowed• NH staff enthusiastically support• ED physicians frustrated with current system
Barriers to Usage
• Cost: $20k per telemedicine unit• Primary care doctors apathy• Hard to get NH nurses to use (as opposed to
old system of calling primary care)
Approach to Increase Use of Telemedicine
• Explain $ advantage• Cost of ambulance • Cost of ED visit-direct• Cost of ED visit-indirect
• Identify physician advocates• Identify nurse “champion” in each facility
Cost of Ambulance Gold-Cross Non-Emergent Emergent Per mile cost
ALS ( monitor, EKG, IV’s, resuscitative measures)
$485.00 $662.00 $11.10
BLS ( IV’s, O2) $404.00 $581.00 $11.00
Capital City Non-Emergent Emergent Per mile cost
ALS ( monitor, EKG, IV’s, resuscitative measures
$235.60 $373.03 $6.87
BLS ( IV’s, O2) $196.33 $314.13 $6.87
o Charges are based on the type of transport plus the per mile costo The cost reflect one way transport only.
Current System
• Sample size 5 nursing homes• 950 transfers over 5 years• Cost per ED visit (transportation, hospital and
physician) $1500• Five year costs 1,425,000
New System
• Capital expense (equipment) $100,000• Leasing costs: $24,000• Cost of emergency visits (665 x 1500)
$997,500• Cost of physician charges: $95,000• Total cost: $1,216,500
Summary for Five Facilities
• Current system: $1,425,000 • Telemedicine system: $1,216,500• Difference (amount saved): $208,5000
Political Barriers
• Attitudes of primary care docs-competition, financial concern, loss of control-
• Attitudes of nurses- resistance to change, reluctance to learn new tool, time factor (call pmd vs move pt to telemed suite)
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