Telehealth after dark: Health systems can relieve clinician workload through nighttime virtual care

Providence St. Joseph Health team members explained during a recent HIMSS20 Digital presentation how their telehospitalist program helped fill the gap for critical access hospitals.

Smaller critical care hospitals may not have the patient volume to justify having a full-time physician for the night hours. 

This, said panelists during a recent HIMSS20 Digital presentation, can mean facilities leverage their daytime doctors for the job – leading, in turn, to burnout and decreased quality of care. Nurses, too, can be stressed by the decision to wake up a physician, leading to decreased job satisfaction and decreased comfort managing complex patients.

“That was the gap we were trying to close for hospitals that wanted to partner with us in establishing a telehospitalist program,” said Pita Nims, RN, and senior clinical program manager at Providence St. Joseph Health, during the InTouch Health-sponsored session, The Telehospitalist Program.

In 2014, she explained, Providence, a Catholic health system encompassing more than 51 hospitals in the western United States, created the telehospitalist program. Through the program, six different critical care facilities across three states access hospitalists during the night shift using bidirectional audiovisual software. 

The clinical service is a remote-attending model that’s available from 7 p.m. to 7 a.m., and includes hospital admissions and cross-cover.

Nims and her copresenter, telehospitalist team lead Dr. Brandon Ong, described how integration between the facilities can lead to improved patient care.

“As a team, we work with … smaller hospitals that maybe don’t have the volume to hire an in-house physician at night, and so obviously use us to fill that gap,” said Ong. “We’ve worked with these programs long enough … so the nurses really have no hesitation to call us for anything, big or small.”

The presenters pointed to the program’s results at select partner critical access hospitals, noting that the program led to an increase in pre-midnight admissions for patients who presented between 2 p.m. and 11 p.m., as well as a decrease in the time to see patients. The program currently serves about 4,000 patients annually; Nims anticipates that it will soon expand to cover eight sites.

“The patients, I think, really appreciate it,” said Ong, with many finding the model to be a novel and interesting one. 

“We always go through the consent [process] at the beginning of our meeting with a patient, and in all the years that I’ve done telehealth I’ve never had a patient say no,” Ong said. “They’d always rather see a physician by video than … not see a physician at all.”