physasst Posted September 12, 2011 Share Posted September 12, 2011 So, I have just finished up the application for a very large grant for the implementation of a telemedicine system throughout our SE state EM system. Without boring you with the details, I am interested in any PA's out there that have used, or use a true telemedicine system and/or perform telemedicine consults. Regardless of specialty. Pros??? Cons??? What would you not change? What would you change? etc.etc.etc. I am helping to co-lead this taskforce, and one thing I keep running into is that I would like to staff the telemedicine consult room with PA's and NP's....while our Department Chair is thinking that if a BC EM physician is calling in for a consult, that it should be a BC EM attending performing the consults..... Have you ever run into this with this scenario, and if so, how did you manage it? Just curious. Link to comment Share on other sites More sharing options...
medic25 Posted September 12, 2011 Share Posted September 12, 2011 I haven't used it personally, but our stroke service uses it with several community ED's in the region for acute strokes. Our neurologist participates in the exam with the ED doc in the community ED to make a decision on whether to use thrombolytics, transfer for interventional procedures, etc. If you're interested in speaking with anyone from the program PM me and I can put you in touch with an APRN who is our stroke coordinator. Link to comment Share on other sites More sharing options...
physasst Posted September 12, 2011 Author Share Posted September 12, 2011 Thanks, I'll probably do that. We're trying to dramatically reduce the number of ED to ED transfers, and either dismiss with outpatient followup (when appropriate) at the outside ED, and then concomitantly increase the number of direct admissions to the floor. Link to comment Share on other sites More sharing options...
lnhNE Posted September 12, 2011 Share Posted September 12, 2011 My primary job is doing pre-op H & Ps for the anesthesia team at the VA and I use telemedicine for 95% of what I do. Telemedicine doesn't necessarily improve/change the patient's medical care, at least not for what I do, but it does help them out with regards to reducing travel time, time off work, gas expenses, etc. Cons- physical exam can be a little difficult depending on what you want to do. With the right stethoscope, there's no difference in auscultation but you do need someone with the pt who's been trained on proper PE skills. Because of certain PE limitations, it may be difficult to use telemedicine for every specialty- but its perfect when you only need to talk to the pt and do a heart/lungs exam. Telemedicine requires some extra work initially because you need to coordinate with different sites, have properly trained staff, have the proper equipment, etc. Having the ability to see the patient's labs and such in real time is also a huge help. Right now, we currently use telemedicine for wound care, mental health, pharmacy, oncology and we're working on a primary care clinic. As for the staffing issue, IMO, using NPs or PAs for the consult would be no different than using a surgical NP/PA to complete a consult on a possible surgical pt in the ED. Link to comment Share on other sites More sharing options...
physasst Posted September 12, 2011 Author Share Posted September 12, 2011 My primary job is doing pre-op H & Ps for the anesthesia team at the VA and I use telemedicine for 95% of what I do. Telemedicine doesn't necessarily improve/change the patient's medical care, at least not for what I do, but it does help them out with regards to reducing travel time, time off work, gas expenses, etc. Cons- physical exam can be a little difficult depending on what you want to do. With the right stethoscope, there's no difference in auscultation but you do need someone with the pt who's been trained on proper PE skills. Because of certain PE limitations, it may be difficult to use telemedicine for every specialty- but its perfect when you only need to talk to the pt and do a heart/lungs exam. Telemedicine requires some extra work initially because you need to coordinate with different sites, have properly trained staff, have the proper equipment, etc. Having the ability to see the patient's labs and such in real time is also a huge help. Right now, we currently use telemedicine for wound care, mental health, pharmacy, oncology and we're working on a primary care clinic. As for the staffing issue, IMO, using NPs or PAs for the consult would be no different than using a surgical NP/PA to complete a consult on a possible surgical pt in the ED. Thanks for the note. Yeah, as part of the grant, we have to limit the initial sites so that we can do it as a prospective, controlled study as well. I'm already in talks for site visits, etc.etc. It's a big project. There was a study in 2006 (Ellis) that showed a 38% reduction in transfers to the ED from a state correctional facility. Not all of those were kept at the prison for treatment, but many of them were made direct admissions. We are hoping (fingers crossed) to duplicate those kinds of results. Link to comment Share on other sites More sharing options...
burnpac Posted September 12, 2011 Share Posted September 12, 2011 Michael, Our group and our hospital uses telemedicine. We have burn units in LA, Santa Ana, Lafayette LA and Phoenix. All of them have HD telemedicine capability, about half of which is wireless and mobile. The software and equipment is all HD and the picture is great. I also have to software on the Windows side of my MacBook Pro so that I can access the system from home. We use the system in the ED, for OP consults, and for routine weekly rounding, when I touch base with our medical administration and have a human moment with West Hills Los Angeles folks and review the unit's patients. When I first started, I would tele into the ED at night to review burn injuries. Our nurse shift leaders are much more experienced now, and I'm comfortable with admissions based on the nursing assessment of the burn and patient history. I then do a hands on assessment in the AM. We also use telemedicine for M and M, and system wide grand rounds as we can pipe powerpoint into the mix to review challenging cases. My surgeon and I also work with the corrections patients, and we do telemedicine clinic every other wednesday to evaluate problems and review the care of inmates at the prisons. This definitely allows for an adequate screening, and many times avoids the transportation of a potentially dangerous inmate to the hospital. Link to comment Share on other sites More sharing options...
Just Steve Posted September 12, 2011 Share Posted September 12, 2011 You may want to consider cross posting this in the Military forum. I was a corpsman on the USS George Washington in the mid 90's and we were beta testing telemedicine during deployment. I assume (dangerous thing to do, I know) that Uncle Sam is still doing it for deployed ships/troops. Link to comment Share on other sites More sharing options...
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