Telemedicine for infectious disease (ID) occurring in patients who are hospitalized may be a promising way to provide ID expertise over a wide population, according to a study published in Clinical Infectious Disease.
Telemedicine services provides growth opportunities for ID clinicians and helps increase access to care while reducing costs. Further, the telemedicine platform can help provide ID expertise over a wide population and allows partnering with various members of the healthcare team in facilities that are otherwise lacking ID specialty access. However, no prior studies have researched inpatient telemedicine practice. Therefore, this study aimed to establish a baseline and assess trends for inpatients who received ID consultation by means of real-time audiovisual linkage (teleID) at a remote hospital.
The teleID process includes consent for treatment on hospital admission with the use of telehealth technologies for patient care and also informs the patient that there will be no recording of the real-time audio or video during the teleID consult. When a doctor at the hub hospital is notified of a new teleID consult, he or she will review the remote hospital’s electronic medical record for the appropriate patient. Then, the ID physician will initiate a call to the remote hospital through video/audio equipment that includes the appropriate HIPAA compliant encryption that calls to a mobile cart with a monitor, microphone, speakers, electronic stethoscope, and handheld examination camera for closer viewing at the remote hospital. After the consultation is complete, the case is reviewed with the requesting provider on the phone and then ID physician will dictate the consult report into the remote hospital’s dictation system, which is then added to the patient’s chart.
In total, 244 patients at 1 remote hospital who were provided with ID consultation either in person, via teleID, or both were included. Data were taken from a manual retrospective chart review of the electronic medical records. The primary outcomes of this study included length of stay, antibiotic usage, and incidence of relapse.
Of the patients, 73 were transferred and seen in person by an ID clinician before the availability of teleID (pre-teleID) and 171 patients were seen via teleID. Results showed that patient length of stay decreased when patients were seen via teleID compared with pre-teleID (P =.0001). However, patients in the teleID group had their ID consult 1 day later compared with patients in the in-person ID consult group, and the time from ID consult order to patient assessment by ID was also longer for patients in the teleID group.
Although the median number of days patients received antibiotics was lower in the teleID group (median=15) compared with the pre-teleID group (median=19), the decrease was not statistically significant (P =.0770). This decrease in antibiotic cost suggests that ID consultation through teleID offered an antibiotic stewardship effect, which serves as a direct cost savings route for the remote hospital. Further, the follow-up data showed no statistically significant difference in relapse rate, but because some patients were lost to follow-up, these data are not complete.
Overall, the study authors concluded that, “ID telemedicine practice directed at inpatients appears to be a promising route of care.”
Monkowski D, Rhodes LV III, Templer S, et al. A retrospective cohort study to assess the impact of an inpatient infectious disease telemedicine consultation service on hospital and patient outcomes [published online April 19, 2019] Clin Infect Dis. doi:10.1093/cid/ciz293