Lessons from the Frontlines of Telehealth

Every patient deserves the best care, regardless of their condition or location. Many patients in rural areas still lack this access, putting their safety at risk. Telehealth technology has grown into one of the most valuable resources for rural hospitals. These are innovations that increase patients’ access to high quality care by providing local care teams with expert guidance and 24/7 monitoring of critically-ill patients. 

One rural health system that’s demonstrating telehealth’s transformational impact on patient care is Avera Health, based in Sioux Falls, South Dakota. Deanna Larson, the CEO of Avera eCARE, spearheads Avera’s telehealth efforts, helping to provide underserved and rural communities with unprecedented access to healthcare. Earlier this year, Deanna was named Woman of the Year by the American Telemedicine Association (ATA) for her demonstrated leadership and continued service to the telehealth industry. Deanna is a leader on the frontlines of telehealth and I was fortunate enough to recently have the chance to discuss with her the power of this technology in rural communities.

Carla Kriwet: What unique patient safety challenges exist in rural areas of the country? 

Deanna Larson: In small rural facilities it’s often not feasible to staff specialists on site. Therefore, clinicians in these facilities face two options when specialty care is needed: send their patients to a higher level of care (sometimes hundreds of miles away), or forego specialty care all together – both of which put patients in danger. Additionally, since rural clinicians are often not provided the opportunity to care for the extremely ill or experience more infrequent cases and diagnoses, they can lack clinical knowledge compared to their counterparts. Even preparing an acutely ill patient for transportation to another facility requires a high level of skill and knowledge to get the patient stabilized enough for a long flight.  

CK: Rural areas like South Dakota are currently facing intensivist shortages and care transportation challenges – when someone becomes ill in isolated communities like these, what options do local care teams have to overcome these challenges?

DL: The first response to the geographic challenge is to look internally at the current care team and evaluate the level of care that can be appropriately provided. Specialty training can be obtained, equipment purchased and protocols established, in the hopes to help the local team care for a high acuity patient. At that point, if the team determines they are facing a significant care deficit for their community that cannot be overcome locally, they begin looking into telemedicine to determine if the external resource can fit their need.

CK: How does the eCARE (eICU to Philips) program specifically help combat these challenges and improve care access and safety?

DL: We strive to support all aspects of care to the ICU patient and the local staff caring for them.  Through the eICU, rural facilities bring specialty care inside their facility and can offer a higher level of care in the ICU. Intensivists are trained to care for the sickest patients, enabling them to manage and guide the care remotely, and eICU providers can review x-rays, see the full electronic medical record and use high-definition cameras to assess patients from thousands of miles away. This high-quality care is simply a button push away for the nurse caring for that patient. While many hospitals have a young nursing staff, our staff has an average of 22 years of nursing experience, allowing us to serve as a helpful resource to newer nurses.

Continuity of care is a well-known safety and quality component to patient care. Being a virtual hospital, eCARE has the unique ability to play a role in the care of patients in nearly all aspects of their hospitalization, from ER, to the medical floor and the ICU. This even occurs when a patient needs a higher level of care. We assist at the critical access hospital in the ER, manage the flight and are ready and waiting for the patient in the eICU.

CK: What were some of the specific changes introduced through the program that improved care quality at Avera?

DL: The program has enabled us to perform best practice rounds and sepsis screenings that have a direct impact on patient care. Since part of our service is catching problems before they occur and filling in gaps in care, the software helps us survey our patients and intervene early if a patient is predicted to deteriorate. Responding quickly to sepsis is essential to achieve a successful outcome and our continuous surveillance has a positive impact on those patients.