How is telehealth used in acute care?
Since the pandemic began, many patients have shifted to a telehealth model for routine concerns, such as a suspected ear infection. In this case, telehealth offers many benefits, such as the ability to receive an appropriate diagnosis and course of treatment without being exposed to sick patients in an office waiting room.
However, when it comes to acute care, in which a patient receives treatment for a severe short-term injury or illness, telehealth hasn't gained as much prominence—most acute care cases require hands-on expertise to treat, either in a hospital setting or doctor's office.
That said, some forms of acute care can combine telehealth with hands-on care, or even rely on telehealth alone, to develop a quick and effective treatment plan. Let's take a look at some scenarios where telehealth can be a part of an acute care treatment plan.
A Hospital at Home program
Some hospitals, suffering from capacity limits due largely to COVID-19 patients, are moving to an innovative "Hospital at Home" model launched by the Centers for Medicare & Medicaid Services to treat certain acute conditions, which include asthma, congestive heart failure, pneumonia, and chronic obstructive pulmonary disease (COPD). While these conditions are typically treated in a hospital system, this program includes an assessment of the patient's home conditions to ensure that they have appropriate utilities, broadband access, and family support, and that any mobility concerns are addressed. The program includes regular monitoring through telehealth as well as daily evaluations by a nurse, either in-person or via telehealth.
"The home hospital approach has repeatedly demonstrated its enormous benefit and value as an important treatment option for patients," Mass General President Peter Slavin, MD, said in a press release issued by CMS." This innovative model has made available safe, cost-effective hospital-level care to patients at home – a reassuring environment that is comfortable, familiar and healing.
Telehealth to tap into expert insights
Telehealth can also be utilized by providers treating patients in ICU units in hospitals, giving the patients access to specialized expert care by physicians who are not physically present in their location.
In these cases, the patients and their bedcare teams are connected remotely through telehealth technology to remote expert providers, who have access to detailed insights around their vital signs and other health metrics. This enables expert providers to provide care outside of their immediate geography, ensuring that patients get access to providers who understand their conditions in detail even if they are in a geographic area with fewer medical resources and an ICU that’s not fully staffed with intensivists.
These telehealth ICU services have been proven to improve outcomes of patients, including reduced length of stay and lower mortality rates, says Lou Silverman, Chairman and CEO of Advanced ICU Care. "The basic benefits of an overall telemedicine strategy typically include accessing an expanded pool of limited clinical resources and improving patient access to high quality healthcare, says Silverman. "Further, a robust telemedicine strategy enables many hospitals to deliver and sustain a higher level of care than would be possible without tapping the efficiency, scalability and cost efficiency of the telemedicine model."
One key area where telehealth can be used effectively in a life-or-death situation is in the diagnosis and treatment of an acute ischemic stroke (AIS), which is the fourth leading cause of death in the United States and the top cause of serious long-term disability.
Many Americans who may suffer from a stroke don’t have access to appropriate specialists, with only 55% of Americans living within 60 miles of a primary stroke center. As a result, many patients are not treated with the most appropriate therapy, tissue plasminogen activator (tPA) because their treating physicians are not comfortable or inexperienced with the treatment method.
By incorporating telehealth services for stroke care management, hospitals are able to call on remote neurologists, who can conduct rapid clinical assessments and make treatment recommendations for the patient's local care team. Several models of telehealth care are available, ranging from consultation/advisory services only; to telethrombolysis, in which the remote neurologist collaborates with the clinician on the patient's treatment plan; and an integrated telehealth system, in which all patient data and therapeutic suggestions are freely exchanged and both parties equally share responsibility for the patient outcome. In some cases, the patient will be moved to the neurologist’s hospital for follow-up care after they have been stabilized.
This model has already resulted in an increase of use of tPA treatment: In rural Bavaria, Germany, tPA utilization increased by an order of 10 once a telestroke network was introduced. Telestroke services can enable rural hospitals to gain access to the expertise they need to provide specialized treatment that improves patient outcomes.
Benefits of telehealth for acute care decisions
Telehealth technology has opened the door to both provide safe and well-monitored treatments of serious conditions at home, and to provide rural or poorly resourced hospital systems with on-demand access to specialized physicians who are able to get a comprehensive picture of each patient's condition, even from afar.
By using connected technology to monitor patients' conditions in detail, remote health practitioners can feel confident in their ability to make treatment decisions safely and effectively. That provides much greater flexibility in where patients are treated, whether at home or an in-care facility, and enables medical teams to rapidly escalate care if a patient’s remote monitoring data signifies potential signs of problems.
In the post COVID-19 world, the use of telehealth is still on the rise, and we can expect that medical facilities will incorporate the use of telehealth and virtual care to improve outcomes for acute care patients in innovative ways.