Sunday, May 15, 2011

Facing Physician Shortages

In healthcare today, we face a changing landscape of national health policy along with increasing patient needs and physician shortages. Remote physician presence using telemedicine technologies leverages the availability of limited resources and ensures that care is available when and where it is needed. Currently, there are only 215 Board Certified neurointensivists in the U.S.

One innovative application provides neurointensivist support and neurologic coverage for hospital emergency departments especially among those designated as a Comprehensive Stroke Centers by the Joint Commission.

According to Dr. Herb Rogove, President and CEO of C2O Medical Group, a remote telemedicine physician program in southern California has demonstrated more rapid patient access to neurological care, better compliance with guidelines, and improvement in national quality standards. These results were presented during a panel on physician compliance and quality metrics at the ATA 2011 Annual Meeting held recently in Tampa.

A team of three remote vascular neurologists also board-certified in NeuroCritical care treated 129 patients over nine months. During this period, the response time for the off-site physicians was 21.8 minutes compared to greater than one hour for local neurologists to physically arrive at the facility.

The remote physicians attained a significant increase in compliance with Joint Commission metrics related to blood clot prevention, clot dissolving medications, cholesterol lowering medications, and stroke education. However, during the course of the following year, compliance by the local neurologist was significantly improved, due to the standard set by the telemedicine NeuroCritical care physicians, as well as the fact that outcome data was shared between both groups.

Physicians are open to new approaches and solutions to the challenges they face on a daily basis. For example, emergency department physicians are too often frustrated because they believe more stroke patients should receive the clot-busting drug t-PA. However, local neurologists are not always available for emergency consultations to identify appropriate candidates. Once the hospital started their telemedicine program, there was an increase in the utilization of t-PA, more complex diagnoses were being made, and more patients were being treated with neurological emergencies.

As Rogove explained, “In order for the implementation to be successful, you need buy-in at the highest executive level. In addition, identifying the opinion leaders and change agents plus involving them in planning is also very important.

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