[Rachel Gross]

In our second case I was the NP and Tyler Goon was the patient. Tyler was recently discharged from the hospital following a stroke and was concerned about his residual right hand weakness, as well as his high blood pressure. Both pharmacologic and non-pharmacologic hypertension treatments were discussed. The patient demonstrated his understanding of these treatments through the teach back method. In regards to Tyler’s residual right handed weakness, we decided that he will start working with OT. OT will help him hone his fine motor skills so that he can complete daily activities such as eating and dressing. Another type of technology that could be used in Tyler’s care is remote patient monitoring. While Tyler was asked to record his daily blood pressures in a note book, report patient monitoring can also be utilized to send blood pressure data straight from Tyler’s device to his electronic chart for the provider to view.

Evaluation

Orientation: 5
Verbal Clarity: 5
Active Listening: 5
Patient-Focused: 5
Tone of Voice: 5
Eye Contact:5
Other Body Language: 5
Empathy: 5
Rapport: 5
Respect: 5
Therapeutic Alliance: 5
Environment: 5
Overall: 5

1. Identifies reason for the visit: 1
2. Confirms that patient agrees with the reason for the visit and accepts that it is delivered by telehealth: 1
3. Obtains history of symptoms or situation: 1
4. Obtains approaches/treatments patient has taken to address the issue: 1
5. Conducts an appropriate physical using equipment at home, and/or other individuals to assist or provides telehealth education using appropriate learning style: 1
6. Discusses findings/Overview of education:1
7. Develop plan (follow-up, referral, medication, etc.): 1
8. Determines patient’s understanding of plan/education: 1
9. Determines how patient will get information on the visit (email, portal, secure text, etc.): 1
Total: 9/9

[Rachel Gross]

I currently work as an RN in the ED. I believe that adopting telehealth as an additional means of ED triage could have several benefits for patients and providers. First, it would help identify patients who need to be seen in the ED vs at primary care or urgent care. Additionally, it could cut down on patient healthcare costs exponentially by decreasing ambulance rides and hospitalizations. Third, it would help alleviate the patient burden in the ED. This would give providers more time to provide unique, individualized and comprehensive care for ED patients.
The best methods of telehealth to utilize for this program would be videoconferencing to speak with and assess the patient and RPM with mHEALTH to obtain important vital signs. While this program would be catered to all patients seeking out emergency services, it would be catered to older adults living in SNFs. Often, these patients are sent to the ED and discharged all within the span of 24 hours. Having an NP use telehealth to triage the patient before he/she leaves the home could help prevent unnecessary and costly ER visits. Additionally, many of these adults require transport to return to the facility. Transport services can take anywhere from 1 -10 hours to arrive. This delay creates a build-up in the ED and also results in older patients being overlooked since they have technically been discharged from the hospital. Telehealth ED triage would help mitigate these issues.
One of the biggest legal considerations for SNF residents participating in this program would be autonomy. Many of these residents lack the capacity to make their own health care decisions and have designated POAs. It is vital that the POA be contacted before initiating the telehealth visit. Additionally, these residents would require the assistance of SNF staff to manage the telehealth logistics. These staff members would need to abide by the HIPAA regulations as well.

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