Effect of Telemanagement in Patients

Discharged to a Skilled Nursing Facility after

a Heart Failure Hospitalization
Santosh Menon MD; Kim Barrows RN; Nancy Rector, MT(ASCP)SM; Mindy
Brewer RN; Tashua Woods-Stroup; Kathleen Daly CNP; Maureen Corl DNP,
CNP; Heather Overbeck MSN, CNP; Amy Dadosky RN; Ken Bertke, RDCS,
CNMT; Natasha Hiles RN; Tracy Preidt RN; Stacey Arnold RN
This research was supported by a grant from Abbott Point of
Care Inc. and The Christ Hospital Foundation
Acknowledgement to Medtech Global USA, LLC
 PURPOSE

The purpose of this study was to

investigate if telemanagement and
point of care laboratory diagnostics
of patients discharged to a skilled
nursing facility (SNF) after a
hospitalization for heart failure
would reduce hospital readmissions
and improve patient self-care
knowledge and satisfaction.
 TECHNOLOGY
Zephyr Biopatch Device
Clinical interventions available (SNF)
Heart Rate
Respiration Rate Change in medication administration
EKG
Posture/Position Lab and radiology testing
Activity minutes
Integrated Ancillary Devices For Zephyr Life Home
Consult for dietitian
System
Respiratory therapy
Blood pressure
Body weight 12-lead EKG
Oxygen saturation
3M Littmann TeleSteth Blue Tooth stethoscope
Abbott i-STAT for point-of-care lab testing
Moderately Complex Testing of B-type Natriuretic
Peptide (BNP)
HIPAA Secure Video by Virtual Care Works, Inc.
 METHODS
Setting
Patients discharged from The Christ Hospital (TCH), a 555- bed, not-for-profit acute care tertiary
facility located in Cincinnati, Ohio to Brookwood Retirement Community for skilled level of care.
Patients were roomed in same hallway at SNF and with consistent staffing.
Patients transitioning home after SNF stay utilized Stay Well Home Health Agency.
Telehealth solutions and laboratory management provided by KBC Global, Inc.
Sample
Patient eligibility:
Admitted with a primary or secondary diagnosis of heart failure
Require skilled level of care after discharge
Established with TCH cardiology group
 METHODS
Data Collection
Readmission rates: utilizing electronic health record review and SNF/HHC report
Patient self-care knowledge and satisfaction: using questionnaire
Intervention
Interactive telemanagement video sessions with Heart Failure Clinic MD or NP facilitated by
SNF/HHC
After transition from hospital to SNF, and from SNF to HHC
As needed for change in patient condition
HF education and monitoring
Duration: Up to 30 days at SNF with an additional 30 days once discharged home with HHC
 RESULTS
Age
141 patients: 49 Sample patients enrolled with 92 control
Median 81
patients
Range (24-98)
7 patients readmitted within 30 days of hospital discharge
(16.7%) Sex

Only one patient readmitted for HF Female 63% (31)

Male 37% (18)
All patients who readmitted were New York Heart NYHA Class
Association (NYHA) Class IV II 4% (2)
Average length of stay during initial hospitalization was 9.3 days , III 35% (17)
26 days at SNF.
IV 61% (30)
Average of one tele management session per patient at SNF, one
at home. HFpEF 57% (28)

Average length of session: 16 minutes HFrEF 43% (21)

Mean EF 22%
Average number of cardiac interventions (medication) per
patient at SNF: 8
There was one expected death.
Costs, Savings and Reduced Hospital Charges

Overall telehealth equipment costs per Approximate $ per Patient

patient $1386.00 for 49 patients. Patient Sensors $126
Tablet Bedside Stands $17
Hospital savings of $9,234.54 due to Littmann Stethoscopes $55
negative EBIDA in this population. Stethoscope License Fee $61
Tablet Hardware/Software, Video
Hospital charges less $99,023.90 based on
License and Customer Service Fees $1,127
reduced readmissions and average HF stay @ $ per Patient $1,386
charges.
 RESULTS
Identified new diagnoses of atrial fibrillation and
pneumonia through video session assessment
Replaced 7 day physician follow-up appointment with
Vidyo appointment at an increased rate as the study
progressed

Demonstrated interaction between patient and other

family members via use of the tablet
Patient comments: thankful, excited, did not
want it to end
 CONCLUSION
Comprehensive telemanagement of heart failure patients discharged to
a skilled nursing facility is feasible and appears to a have a favorable
effect on 30-day all cause readmissions.
Technology was well-received with high patient satisfaction and ease of
use reported in elderly patients with HF.
Telemanagement is a new method used to achieve reduced
readmission rates even in high risk populations admitted to SNFs.
This technology has the potential to enhance communication between
the discharging team, the patient, the skilled nursing facility, home care
agency, and heart failure team.