“Like most hospitals, ours saw a 50% decrease in volume early in the pandemic. Yet we knew that of course, patients still needed care. We were forced to be creative in finding solutions to reaching those patients,” said Dr. Andrew Lim (pictured left), Emergency Department Medical Director at Bristol Hospital.
Dr. Lim started by focusing on something that he could control. Many patients had been calling the hospital to see if the emergency department waiting room was busy; asking if it was safe, and if they needed to be seen. One evening, he overheard a nurse on the phone with a patient who was debating coming into the ED. The nurse told the patient that she couldn’t provide medical care over the phone, and that the patient would need to see his family physician or come into the emergency department.
“A lightbulb went off,” Dr. Lim said. “I realized we could see patients via technology. Telehealth just hadn’t been implemented in EDs. Yet. Thanks to technology, there had to be a way to treat patients remotely. There were a lot of new laws saying we can and should be doing this – we just needed to figure out how.”
Lim and his team quickly figured out the details, and set up the process using video chat. The visits went one of two ways – the patient was safe to stay home and clinicians called in a prescription if needed; or, the patient came into the emergency department for further tests and treatments.
“If the patient comes into the ED, we waive the telehealth fee. It also puts both provider and patient one step ahead of the game,” said Lim. “I know exactly what tests to order, and the patient doesn’t have to tell me the whole story again. It really expedites the process.”
Telehealth actually also provides great benefits to the hospital. In addition to bringing in new patients who might have chosen a different hospital and to refer patients into the hospital network, Bristol has also been able to use telehealth for another need that arose during the pandemic: hospital employee screening. If an employee suspects they might have COVID-19, they can get swabbed for the virus in their car. Telehealth also allows for appropriate screening and consent, also ensuring that the monoclonal antibody treatment, if needed, in stock before the patient arrived to the hospital.
Nationally, US Acute Care Solutions has also been working to leverage Dr. Lim’s innovative work and it bring it to other hospitals. “The COVID-19 pandemic and its associated policy changes have been a real facilitator in implementing similar programs. We have now launched, or are launching similar programs, in sites in Texas, North Carolina, Virginia, and Colorado,” said Dr. Jesse Pines, the USACS National Director of Clinical Innovation. “In the future, I see telehealth as a basis of competition. In many cases, people often don’t know whether they’re having an emergency, and we can provide near real-time access to emergency medicine specialists. It’s a solution that patients want and need.”
“One of the best things about telehealth is that it gives us a lot more control over our environment,” said Lim. “Both providers and patients are less exposed to COVID. We were able to explain to patients what needs to happen before they came to the ED. It’s been good for us, and good for the hospital. Telehealth can definitely continue to benefit the community.”
One community member had called four different emergency departments seeking advice for abdominal pain.
“The three prior emergency departments refused to give her medical advice, and she was too scared about COVID exposure to check into a hospital,” said Dr. Lim. “After evaluating her over a video chat, I recommended an in-person evaluation, and took care of her in person that same day. This was her first experience with our healthcare system, and she soon chose one of our PCPs and had an upper endoscopy performed by our gastroenterologist the next week.”
Bristol Health Hospital has wholeheartedly embraced Telehealth, and has heavily invested in marketing it to the local community. And ultimately, Dr. Lim believes that telehealth has helped prevent deaths.
“Telehealth will likely be a lasting change that will outlive the pandemic, delivering a great way to interact with emergency departments and that adds clear value, all around,” said Dr. Pines.
“We’re able to get people into the ED who have life-threatening emergencies,” Dr. Lim said. “We’ve been able to provide advice that both improved the trajectory of their illness – and, in several cases, saved their lives.”
Bristol Health was named a 2020 Press Ganey Leading Innovator for its efforts in making telehealth available to its community.