Abstract: SA-PO059
Outcomes of Using Telemedicine to Provide Nephrology Care in Rural Hospitals
Session Information
- Engineering-Based Approaches to Problems in Nephrology
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Bioengineering
- 300 Bioengineering
Authors
- Lea, Janice P., Emory University, Atlanta, Georgia, United States
- Cobb, Jason, Emory University School of Medicine, Atlanta, Georgia, United States
- Navarrete, Jose E., Emory University, Atlanta, Georgia, United States
- Masud, Tahsin, Emory University, Atlanta, Georgia, United States
- Tannenbaum, Jerome S., Sanderling Healthcare, LLC, Nashville, Tennessee, United States
Group or Team Name
- Emory University
Background
Telemedicine has recently permeated into the nephrology space allowing patients in rural underserved areas to be treated in their local hospitals without transfer to larger healthcare systems miles away. We report our two year experience providing telenephrology consult services to both ESRD and non- ESRD patients in rural hospitals.
Methods
A retrospective, descriptive study of patients receiving tele-nephrology consultation and chronic dialysis services between September 2017 and May 2019 in three South Georgia (GA) rural hospitals. Consultations were requested by the on-site physicians and were performed by Emory University Tele-nephrologists based in Atlanta,GA by reviewing the patient’s hospital electronic medical record (EMR) and performing a real-time history and physical exam with audio-video technology and Littman electronic stethoscope. Nephrologists documented treatment plan in the hospital’s EMR on each follow-up visit and provided orders for dialysis when indicated using portable dialysis machines that captured electronic data on each HD session.
Results
In three rural hospitals we provided care to 128 unique patients (pts) with a total of 525 patient encounters. Average age for ESRD pts - 59 and for non-ESRD- 66. 60% of the consults were in dialysis patients with congestive heart failure being the major admitting diagnosis in 42%, while 88% of ESRD pts were discharged to home. For the non-ESRD consults: 24.6% were acute kidney injury who had 71% renal recovery at discharge; and 15.6% were electrolyte disorders- mainly hyponatremia. 34% of overall renal consult patients were treated in the ICU with 8.3% requiring pressor support. See Table for other outcomes including length of stay (LOS), mortality rate, and discharge status (DC) for both the ESRD and non-ESRD patients.
Conclusion
Both ESRD and non-ESRD patients in rural hospitals who received nephrology care via telemedicine were effectively managed in their local hospitals, had low mortality rates, and had similar LOS to larger healthcare systems. Telemedicine is an innovative and feasible option to provide specialty care in rural hospitals.
Clinical Outcomes of Rural Hospital Patients Managed by Telenephrology Sevices
LOS (days) | Mortality | Transfer to higher level of care | DC to skilled nursing/LTAC | |
ESRD (n=76) | 4.3 | 0 | 5.7% | 3.8% |
non-ESRD (n=52) | 7.1 | 5.7% | 11.4% | 14.3% |