Low Tech Telemedicine
An enormous amount of health care dollars are spend every year on high dollar telemedicine technology with the goal of improving patient care. We support technology in health care. It is clearly the way of the future and any and all tools available to agencies should be employed when they promote communication and patient care.
But before your agency purchases high dollar equipment, are you completely sure that all technology currently available to you is being used? What about the expensive telephone system that decorates your office?
In determining frequencies, we generally try to establish how often the patient will require visits by the clinician. Most Clinicians, in an effort to err on the side of caution, will schedule generously. What many agencies have already discovered is that certain follow-up tasks can be accomplished with a short phone call in lieu of a visit.
Consider a newly diagnosed diabetic patient who is seen five times in succession on the first week of admission with plans to reduce visits to twice weekly after the skill of blood glucose monitoring is mastered by the patient. At the end of the fifth visit, the patient is able to independently perform the skill but is still a little unsure. The nurse might very easily perform a sixth visit to ensure that the patient is comfortable performing a new skill. Or, maybe, all the patient really needs is a little reassurance in the form of a telephone call.
This same logic applies to reducing frequencies at time of recert or after an acute exacerbation. It isn’t necessary to drop cold turkey to a lower frequency. A phone call to check on the patient between visits goes a long way to ensure the nurse that the correct clinical decision has been made. And obviously, should a need become apparent during a phone call, an additional visit can always be added to the schedule.
Other phone calls I would like to see made include:
- Phone calls after visits missed due to no answer to locked door.
- Phone calls after MD visits
- Phone calls when there is a change in caregiver situations at the house
Follow up after the beginning of a new medication or the cessation of a long term medication
Of course, all the phone calls in the world won’t go far to protect you in a survey or payment review situation. But considering that care coordination deficiencies are among the most commonly cited survey deficiency, the process of making phone calls and including documentation in the clinical record can go far to show the quality of care your agency gives.
To make it easy for nurses to improve care coordination through low tech telemedicine techniques, clean and uncluttered forms should be available. Consider including a stack with weekly schedules. Add checkboxes for physician and interdisciplinary communication to ensure that coordination is well documented.