Project Report
Teleneurology service provided via tablet technology: 3-year outcomes and physician satisfaction
AUTHORS
Kelly Harper1 BPS, Program Manager
Megan McLeod2 BBA, Medical Student
Summer K Brown3 BA, Masters student
Georgia Wilson4 BA, Clinical Research Coordinator I *
Maxim Turchan5 BA, Health and Policy Services Analyist II
Emily M Gittings6 Student
Derek Riebau7 MD, Assistant Professor
Mark Baker8 MD, Assistant Professor
Eli Zimmerman9 MD, Assistant Professor
David Charles10 MD, Professor and Vice-Chair of Neurology, Medical Director Vanderbilt TeleHealth
AFFILIATIONS
1, 5, 7, 8, 9, 10 Vanderbilt University Medical Center, Nashville, Tennessee, USA
2 University of Mississippi, Oxford, Mississippi, USA
3 Vanderbilt University, Nashville, Tennessee, USA
4 Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
6 McGill University, Montreal, Canada
ACCEPTED: 20 November 2018
early abstract:
Purpose: To demonstrate that teleneurology consultations conducted via tablet technology are an efficient and cost-effective means of managing acute neurologic emergencies at community-based hospitals and that utilizing such technology yields high community physician satisfaction.
Methods: During a 39-month period, Vanderbilt University Medical Center (VUMC) provided teleneurology services to ten community-based hospitals that lacked adequate neurology coverage. Hospitalists at one community-based hospital were not comfortable treating any patient with a neurologic symptom, resulting in 100% of those patients being transferred. This facility now retains more than 60% of neurology patients. For under $1200, these hospitals were able to meet the only capital expenditure required to launch this service: the purchase of handheld tablet computers. Real-time teleneurology consultations were conducted via tablet using two-way video conferencing, radiologic image sharing, and medical record documentation. Community physicians were regularly surveyed to assess satisfaction.
Results: From February 2014 to May 2017, 3,626 teleneurology consultations were conducted. Community physicians, in partnership with neurologists, successfully managed 87% of patients at the community-based hospital. Only 13% of patients required transfer to another facility for a higher level of care. The most common diagnoses included stroke (34%), seizure (11%), and headache/migraine (6%). The average time for the neurologist to answer a request for consultation page and connect with the community physician was 10.6 minutes. Ninety-one percent of community physicians were satisfied or somewhat satisfied with the overall service.
Conclusions: In the assessment of neurology patients, tablets are a more cost-effective alternative to traditional telehealth technologies. The devices promote efficiency in consultations through ease of use and low transfer rates, and survey results indicate community physician satisfaction.