Finding emergency department staff has always been a challenge for Baptist Health, which is headquartered in Louisville, Kentucky, and operates in that state and Indiana.
THE PROBLEM
Baptist Health staff can look at past patterns, but sometimes still struggle to accurately predict specific days and times. Additionally, with the current challenges in healthcare, even if Baptist Health recognizes the need for additional staffing, it may not have the resources to appropriately deploy additional staffing.
“Our urgent care center wait times, and therefore the patient experience, can be significantly impacted by this unpredictable ebb and flow of patients presenting,” said Dr. Brett A. Oliver, Chief Medical Information Officer at Baptist Health. “This is especially true in the last hour or so before a clinic closes.
“Actually, an urgent care in our market in Hardin had a competitor change their hours and close early, which resulted in an even higher volume of patients at our location at the end of the day,” he continued.
“This influx of patients leads to long wait times, which is not good for patients. In addition, caregivers and staff have to stay longer, which is not good for their experience and can lead to higher costs for the healthcare system.”
Because the health system could not provide staff, providers, or additional exam rooms, it had to find ways to increase throughput and provide patients with the fastest and most appropriate form of clinical care.
PROPOSAL
The proposal was to a standalone video visit kiosk at emergency departments to offer patients with lower urgency issues an alternative to the longer wait time to be seen in person.
“When patients arrive and their chief complaint is on a pre-approved list of issues that can be reviewed virtually, the front desk staff simply offers them options,” said Nick Sarantis, system director of digital health at Baptist Health. “For example, the staff might say, ‘Our current wait time is about 90 minutes; but with your current complaint, we have a virtual option and the virtual provider can see you right away.’”
“If the patient chooses the virtual option, they are directed back to the self-service kiosk, log in to their MyChart account on the tablet, and are placed in line with our pool of virtual emergency care providers,” he continued. “These virtual care providers are centralized in our system and were already available 24/7 for other virtual care needs prior to the ED rollout.”
“Where else can you get healthcare with a wait time of only six minutes, especially as a walk-in patient?”
Dr. Brett A. Oliver, Baptist Health
With this robust telemedicine device, from supplier TytoCare, the visit is more than a simple video connection. The virtual caregiver can listen to a patient’s heart and lungs, look into their ears and throat, and examine their skin and eyes. This is a major advance over the traditional video visit.
“When our virtual caregivers see ‘TytoClinic’ on their calendar, they immediately move them to the top of the queue because these are patients waiting in an urgent care location, not patients waiting at home,” Sarantis explains.
“If we can offer patients a faster option to be seen, that is convenient for the patient and it reduces the time that caregivers and staff have to be on site.”
TOOK UP THE CHALLENGE
The TytoClinic allows patients to be seen virtually instead of having to wait in person for a long time. It also exposes patients to a technology they can use at home if they experience a similar problem in the future.
“Patients using the TytoClinic system, which is integrated into our Epic EHR, log into their MyChart account, and the virtual EDs connect to that patient through their Epic chart,” Oliver said. “Documentation is also done through Epic. No scanned documents.
“The virtual urgent care notes are stored in Epic, just as if they were viewed in person, so other caregivers can review them,” he added. “The great thing is that if the virtual caregiver determines the patient needs a higher level of care, they can easily be transferred to the in-person caregiver at that location.”
RESULTS
In the eight months since implementation, Baptist Health has had approximately 1,700 TytoClinic visits from EDs. The median wait time was just six minutes.
“Where else could you get a health care service with a wait time of just six minutes, especially as a walk-in patient?” asked Oliver. “We’ve been really pleased with how patients have embraced this option and how some of our busier clinics have used the technology.”
One patient commented that Oliver reported, “I am visiting the ER for flu-like symptoms. Barbi introduced me to the virtual visit. I just wanted to say how much I enjoyed it. I feel like I received the same level of care as I would have received in person. Everyone was still very professional even though I was speaking to the doctor through a screen. Thank you for seeing me this way.”
Following this success, Baptist Health decided to test a TytoClinic device in all of its primary care practices in one of its markets.
“This is generally a more rural market where sending someone to an emergency room can mean driving an hour or more,” Oliver explained. “By adding the device to these offices, we’ve in many ways added an urgent care location for patients in these neighborhoods. We’re excited about the increased access we’ll provide in these underserved areas.”
ADVICE FOR OTHERS
For colleagues who want to run a similar business Oliver and Sarantis encourage them to remain engaged with operational partners in the telemedicine program throughout implementation.
“It was really by listening to the operational challenges in our emergency care settings that we were able to provide this solution,” Sarantis noted. “This strong partnership has really delivered benefits for our patients and staff.
“Implementing the technology is the easy part, but the change management to implement a whole new workflow requires a lot of communication and follow-up,” he concluded. “To maintain camaraderie and communication after go-live, our digital health team sponsored a pizza party contest for the urgent care clinic with the most telemedicine visits in a month.”
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