Anne Carle, RN, Telehealth Clinical Coordinator at Cornerstone VNA, shares how video conferencing helps shape the way she cares for her patients. Anne discusses how video conferencing can prevent re-hospitalizations and even save lives. She also explains how video conferencing can improve healthcare efficiency and enhance a patient's quality of life.
Enhancing Patient Care with Telehealth
Telehealth is used to monitor high risk patients with chronic conditions on a daily basis in order to prevent emergency department (ED) visits, reduce re-hospitalizations, cut agency costs, and decrease nursing visits. Cornerstone VNA (CVNA) has used telehealth monitoring for 20 years. In 2016, our agency partnered with Health Recovery Solutions (HRS) with the goal of establishing a more advanced remote patient monitoring system.
The HRS telehealth software pairs with 4G Samsung tablets and wireless remote patient monitoring devices that consist of a blood pressure machine with cuff, a pulse oximeter device to measure O2 saturation and heart rate, and a weight scale. Each tablet is customized to the patient’s disease and includes educational videos and disease specific survey questions. The software also offers video conferencing and medication reminders. Thanks to the HRS telehealth tablets, CVNA provides more advanced care and monitoring to patients with diagnoses such as CHF (Congestive Heart Failure), COPD (Chronic Obstructive Pulmonary Disease), and Pneumonia.
The Power of Video Conferencing
While the software and the 4G Samsung tablets offer many wonderful features, the most powerful tool available is video conferencing. As a telehealth nurse at CVNA, I use video conferencing on a daily basis. When a patient is first introduced to the telehealth system, the clinicians at CVNA utilize this tool to introduce me to the patient and to put a face to my voice. This engages the patients and encourages them to use video conferencing as a method of communication.
I use the telehealth system to monitor the patients' vital signs, weights, and survey questions on “how they are feeling” right from my office via a web portal. If I see any irregularity come through, I use video conferencing to perform a visual assessment of the patient in his or her home.
The options with video conferencing are endless. I use it to ensure that our COPD patients are using their inhalers properly by conducting virtual inhaler training. The video capability also allows me to visually see wounds or incision sites for signs and symptoms of infection. Additionally, I use video communication to provide emotional support to patients with high anxiety or depression.
With my findings, I can help prevent ED visits and re-hospitalizations. I am also able to provide accurate reports to the patients' physicians. This allows the physician to treat the patients' conditions if necessary and prevent a serious situation from occurring.
Saving a Patient's Life
On two separate occasions, video conferencing saved a patient’s life. One day I noticed via the web portal that my patient demonstrated a low O2 saturation in the 70s. We were talking on the phone when I noticed her oxygen level drop from the high 90’s to the 70’s. I immediately connected with the patient through video conferencing and I was able to see how much she was struggling to breathe. I also noted that she was gray in color. Her husband was frantic and unsure of what to do. Because of the video conference, I was able to get the immediate attention the patient needed by calling 911 and therefore prevented a more serious situation. I was also able to ease her husband's fears.
My experience with the second patient was similar in that he experienced a dramatic drop in O2 saturation as well. Once I saw this patient over video, I realized that he was not wearing his nasal cannula. I also noticed that his lips were blue. I immediately instructed the patient to put his oxygen back on. I then demonstrated and performed pursed lip breathing techniques. Shortly thereafter, his O2 saturation climbed back into the 90’s. The patient also regained color in his face. If not for video conferencing, this incident could have resulted in a re-hospitalization for this patient.
Providing Real Time Care from Afar
One day I received a phone call from a patient telling me that she spilled her pill planner and needed assistance refiling it. Her son manages her medications, but he was at work and was not going to return home until 4:30 that afternoon. I knew the patient needed to take her morning medications, so I decided to connect with her over video to help resolve the issue. Using video conferencing, I was able to assist the patient in filling her pill planner. She was therefore able to take her morning medications. The patient told me she was so grateful to feel like a nurse was actually in her home helping her.
That same day I had a patient express to me over the phone that her lower leg was red with bumps. I connected with the patient using video conferencing and I was able to visually see the site. After seeing her leg, it appeared to me that she could have been displaying early signs of cellulitis. This information was reported to the physician and the patient was seen in the office that same day. The patient was diagnosed with early signs of cellulitis and was prescribed an oral antibiotic. In this case, video conferencing took the place of a nursing visit, an ED visit, and a hospitalization, which would have likely ended with the patient needing IV antibiotics.
Improving Outcomes with Video Conferencing
The utilization of video conferencing in our telehealth program at CVNA has cut down on nursing visits, reduced costs, lowered visits to the ED, and limited the number of re-hospitalizations. We are proud to share our most recent readmission data from 1/1/2018 to 5/11/2018. During this time frame, we saw 24 telehealth patients, only one of which had a preventable 30-day readmission. This yielded a 4.2% readmission rate, which is much lower than the national average 30-day readmission rate of 21.6%. Our considerably low readmission rate among these 24 patients resulted in $54,392 in cost savings.
Video conferencing is a feature of telehealth that improves quality of care, facilitates healthier outcomes for patients, and saves lives. We are proud to be able to offer this service to our patients.