Becker's Hospital Review

44 Executive Briefing Sponsored by: W hen a patient presents to the emergency department (ED) with symptoms of a stroke, clinicians need to act fast. Stroke patients who receive medical care within three hours of initial symptoms are less likely to suffer lasting effects than those who receive delayed care, according to the American Stroke Association. As the U.S. population ages, the prevalence of stroke and other neurogenerative disorders will continue to rise. This trend coincides with a diminishing number of available EDs around the nation. Between 1993 and 2013, ED visits increased by more than 40 percent, but the number of available EDs decreased by 11 percent, according to research published by The U.S. Department of Health and Human Services (HHS) in 2016. The combination of these trends puts a strain on our hospital systems and compromises the ability of patients to receive the timeliest and most appropriate care possible. To alleviate this strain and improve care, particularly for patients with acute neurologic needs, hospitals have been implementing hospitalist programs and leveraging telehealth innovations. These non-traditional approaches connect patients with highly specialized experts in a flexible and on-demand manner. Vituity, a physician-led and -owned, multi-specialty partnership is partnering with hospitals to deploy new delivery models and establish in-house programs. Among its offerings is a telehealth solution that connects Vituity's medical experts with physicians in the ED and inpatient settings for 24/7 advice on care delivery. Becker's Hospital Review spoke with three Vituity physician leaders— Rick Newell, MD, Chief Transformation Officer; Yafa Minazad, DO, Vice President of Acute Neurology; and Arbi Ohanian, MD, Vice President of Acute Neurology — to learn more about the demand for integrated specialty services and how Vituity is using teleneurology to create an integrated experience. Editor's note: Responses have been lightly edited for clarity and brevity. Question: What are the unique specialist care needs of EDs and hospitals? Are they being met today? Dr. Richard Newell: Hospital and ED specialist coverage needs vary based on the facility and the community in which it is located. However, in my experience, EDs have a significant and growing need for specialist coverage, regardless of the facility or community. From a neurology standpoint, we're seeing a rapidly aging patient population and an increase in ED visits for neurovascular emergencies, neurodegenerative conditions, and other neurologic emergencies. We're also seeing more emergencies on the behavioral health side, so it's across specialties. It's estimated that approximately 10 percent of ED visits are due to behavioral health conditions, and we all know that EDs and hospitals lack the psychiatric support and resources needed to manage these patients. At the end of the day, it's a strained system. We see prolonged ED stays, poorer patient outcomes, and a drop in patient satisfaction as a result of this lack of access to specialists. Q: Why should a hospital consider implementing a neurohospitalist program? Dr. Arbi Ohanian: There's a misconception that internal medicine physicians can manage all neurologic care, but neurology requires much more rigorous training than what is taught in an internal medicine residency. Neurology is a specialty of its own. To appropriately care for complex neurologic patients, it's best to have a neurohospitalist evaluate and manage that patient. At hospitals where we implement these programs, we see appropriate ordering of tests, decreased length of stay, better outcomes, and increased patient satisfaction. Q: Can you describe how teleneurology works in the ED setting? Dr. Yafa Minazad: We have a video-conferencing cart that is HIPAA-compliant in the emergency department. It provides physicians with the equipment to conduct neurological examinations and provide recommendations in a very timely manner. Often, when a patient comes to an emergency department with stroke symptoms, the community neurologist will be notified and then will need to travel to the hospital, evaluate Integrating telehealth in the ED increases patient access to care and delivers improved results

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