VA Tele-Nurse Reaches
Out and Touches Someone
has arrived at the Tampa, Fla., VA Medical Center, and members of
the Home Based Primary Care (HBPC) team are finding the new technology
a valuable tool for monitoring patients with chronic medical conditions
who live in outlying areas.
has tremendous potential for giving patients that live a distance
from the medical center better access to our care," said Ofelia
Granadillo, a board-certified social worker and program director
of the HBPC team. "The increased access to care providers improves
communication and increases the patients feelings of security."
The new system
relies on a TeleHomeCare computer monitor installed in each patients
home. With the monitor, a VA "tele-nurse" makes weekly
telephone calls from the HBPC office to the patients home.
When the phone rings, the patient answers by pushing a green button
on the home monitor. Voice communications are established through
a speakerphone, and after about 30 seconds, a video display allows
both the tele-nurse and the patient to see each other. Thats
when the examination begins.
orange button on the monitor activates a diagnostic-quality electronic
stethoscope, allowing the tele-nurse to listen to the patients
heart, lung and bowel sounds. Pushing the blue button activates
a blood pressure cuff, allowing the patient to check his or her
blood pressure and pulse, and report the findings to the tele-nurse.
A system is currently being tested that would allow tele-nurses
to upload a patients vital signs directly into VAs computerized
patient record system.
Program is reinforced with a comprehensive patient education program
that emphasizes self-management of chronic illnesses. Patients learn
about topics such as medication management, understanding the disease
process, home safety, nutrition, and health promotion. In addition,
a tele-social worker addresses such topics as end-of-life planning
and emotional health. Patients are also asked to keep a daily diary
of their symptoms, weight and vital signs. The diary includes standard
yes-or-no questions specific to the patients illness.
Dr. June Leland, medical director of the HBPC team, the program
has yielded some surprising results patients are spending
less time in the hospital. Consider the case of 73-year-old veteran
Norman Adams. Diagnosed with several medical conditions, including
congestive heart failure (CHF), he was hospitalized seven times
for a total of 29 hospital days during the year prior to joining
the TeleHomeCare Program. Since enrolling in July 1999, he has yet
to be admitted to the hospital. "This is one of the most wonderful
things that has happened to me," said Adams from his Florida
home, smiling as he looked through the video monitor during a live
demonstration of the telemedicine technology in at VA Headquarters
in Washington, D.C.
Adams is not
alone. The 17 patients currently participating in the program required
a combined 288 hospital days during the 12-month period prior to
joining the program. Based on current trends, the HBPC team projects
a 57 percent decrease in cumulative hospital days for the 12-month
period following their admission into the program, from 288 to 164
is complementing our entire HBPC program," said Dr. Leland.
"Through reduced hospital patient days, this program is saving
valuable federal funds, while increasing patient satisfaction."
in the program, patients must have a diagnosis of CHF and/or chronic
obstructive pulmonary disease (COPD), live more than 30 miles from
the medical center and have had at least two admissions to the hospital
for CHF and/or COPD, or two or more visits to the emergency room
in the past year.
on VAs telemedicine program, call John Peters in VA Headquarters
Tele-medicine Strategic Healthcare Group at 202-273-8508.
is in the Public Affairs Office at the Department of Veterans Affairs
in Washington, DC. You may reach him at firstname.lastname@example.org.