Does the Use of Telemonitoring in the Care of Heart Failure Patients Reduce Hospitalization?
The heart is a vital organ that the body needs in order to survive and according to the Center for Disease Control (CDC) 5.7 million people in the United States suffer from heart failure (HF) and about half of heart failure patients die within five years of diagnosis, (CDC, n.d.). Heart failure is the inability of the heart to pump blood sufficiently in order to meet the body’s need. Heart failure is the main reason for inpatient hospitalization and readmission in adults over 65 years old (Smith, 2013). Advances in technology continue to change the practice of nursing and healthcare. Telemonitoring is one major advance in technology that is changing the role and practice of nursing today. Telemonitoring involves healthcare workers remotely monitoring patient’s vital signs daily with the goal of early detection of deteriorating conditions. This systematic review will present available data regarding telemonitoring in heart failure patients and hospitalization.
Research Question Does the Use of Telemonitoring In the Care of Heart Failure Patients Reduce Hospitalization?
Systematically Reviewed Literature
Telemonitoring Reduces Hospitalizations
Pedone et al. (2015) conducted a randomized trial study that evaluated the effect of telemonitoring and hospital admissions of elderly patients with heart failure. The study involved a final sample size of 90 participants: 43 from
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Situation: Two patients in their 70s present to the office at different times today, each with documented heart failure: one diastolic and the other systolic, and both are hypertensive. First, discuss the difference between systolic and diastolic heart failure, providing appropriate pathophysiology. ACEI/ARBs are the only medications prescribed for CHF that have been found to prolong life and improve the quality of that life. EXPLAIN the mechanism of action of ACEI/ARBs and how they affect morbidity and mortality in CHF. Be specific. Diuretics must be used very carefully in diastolic ventricular dysfunction. EXPLAIN this statement using appropriate physiology. Now considering all of the above, describe an appropriate comprehensive plan of
The study was a systematic review conducted using published and unpublished studies. The aim was to examine the impact of telemedicine intensive care unit (Tele-ICU) and the coverage on mortality and length of stay (LOS (Young, Chan, Lu, Nallamothu, Sasson & Cram, 2011).
monitored by medical professionals. According to McKnight (2012), “Studies indicate patients with telehealth care are noted to have a 25% reduction in the number of inpatient hospital days and a 19% reduction in the rate of hospitalizations” (p. 4).
The benefits of telehealth consultations are immeasurable; clients are able to access a knowledgeable health care professional and receive a telephone triage/assessment and recommendations. This allows the patient to have immediate access to good health advice and quicker solutions. Telemedicine is one of the many vehicles of telehealth; for example, the cardiologist orders an outpatient Holter Monitor trial to evaluate arrhythmias. The technician calls the patient at the sign of any abnormal rhythm and investigate the activity performed when the reading fluctuation then the reported is communicated to the cardiologist. If warranted, the cardiology staff will contact the patient with instructions schedule an immediate appointment. Telehealth services resources would benefit the client in this next example, an individual’s come in for a sick visit expecting a prescription to be written for their illness; they receive informative instructions because of the nature of the
Telehealth has been a large topic of debate in recent years because of the economic, political, and regulatory points of view. In deciding outcomes in these areas, it is the responsibility of all healthcare professions to identify information gaps in order to come to the more rational and beneficial conclusion about telehealth (Grace, 2014). Economically, there are concerns regarding the access and affordability of telehealth equipment. At the same time, telehealth is being adapted in ways to be utilized with technological devices that many individuals already have access to like telephones, cellular phones, and personal computers/laptops. Telehealth can positively impact both clients and providers by increasing access to care and reducing the time and costs associated with traveling for health care (Allen, Aylott, Loyola, Moric, & Saffarek, 2015). As telehealth develops technological devices can be made more affordable and can be covered by insurance policies (Thomas et al., 2014). Many nurses functioning as case managers can help provide the tools and resources individuals require to manage their health.
This assignment will take the form of a case study on a current patient with heart failure being nursed in a community setting. Due to confidentiality and patient privacy, the patient discussed will be referred to as John¹.
When patients leave from appointments with their physicians, or are discharged from the hospital, they are responsible for their care at home. Oftentimes, patients are non-compliant with their treatment plan given to them by their clinician due to lack of understanding, miscommunication or faulty understanding of the treatment plan, lack of access to facilities or requirement of additional guidance. This creates safety issues and causes negative outcomes in the patients’ health. This is where telehealth comes into play to help to continuously monitor patients and provide the assistance needed to maintain optimal patient function. According Cassandra, Graves, and Mooney (2013) telehealth would certainly reduce readmission rates for chronic conditions by giving patients early interventions, serve wider geographic areas, improve patient outcome, provide better services to patients and allow better time management for
UNDERSTANDING TELEHEALTH SECTION 1: Modalities/Models High-risk obstetrical telehealth has been used to provide any number of support diagnostic and ancillary services, including nonstress testing, fetal echocardiograms, hypertension and diabetes counseling and monitoring, and a number of others. Nonstress testing, meaning no stress placed on the fetus, is done by placing a belt with a sensor on the abdomen of the mother to monitor fetal heart rate in response to fetal movement (1). Fetal echocardiograms use ultrasound equipment to evaluate the heart of the fetus and assess for cardiac abnormalities prior to birth. These tests are performed most often in the second trimester and provide a more detailed image than a regular ultrasound and show blood flow, structure, and heart rhythm (2). Each of these test results can then be read in the office or remotely via real time teleultrasounds and video technology. Additionally, common medical complications in high-risk pregnancies, such as hypertension and diabetes, can be remotely monitored through the use of a handheld or wearable device and can also be used as an educational/counseling tool. Increasingly, high-risk obstetrical telehealth is making its way into the home, providing patients the opportunity to increase time in between required clinic visits, replace visits, or offer providers rich data on patients in between appointments. This amazing evolution of high-risk obstetrical care is currently underway and is expected to
Currently, the DVAMC’s telehealth department is fully staffed with ten nursing coordinators that manage a variety of chronic diseases and health promotion topics such as smoking cessation and weight loss. The telemedicine service includes: TeleRetinal, TeleMental Health, TeleDermatology. Furthermore, educating the staff and patients about the department’s services is an established activity delegated to the telehealth coordinators as well as marketing all the service to other medical staff. In addition, the technology as well as the reports to be utilize to measure the outcomes of the project are existing, functioning systems within the facility. Therefore, there will be no additional cost associated with purchasing equipment nor manhours to implement this project.
The framework for telehealth builds on the successful outcomes including patient satisfaction and reductions in hospital readmissions. Veterans Health Administration’s telehealth services reported patient satisfaction levels greater than 85%, and reductions in bed days of care exceeded 40% among patients receiving the care technology. The Framework provides a vision, direction, and systematic approach for utilizing telehealth both statewide and locally. The framework will also be a tool to educate decision-makers on the impact of chronic disease, the importance of prevention, and the potential economic return of investment in a proven, community-based
Cardiac telemetry nurses specialize in cardiac care and in the use of electrocardiogram equipment. They must systematically apply their nursing judgment skills to perform assessments designed to evaluate pain, psycho-social background and patient education needs. Based on this information, they must identify risks, make diagnoses, generate goals and establish expectations. They must be able to continually prioritize and implement changing nursing plans according to updates or new information. They collaborate with patient team members on a daily basis to coordinate care and meet the needs of their patients.
Telehealth is the monitoring via remote exchange of physiological data between a patient at home and health care professionals at hospitals or clinics to assist with diagnosis and treatment. As our society ages and health care costs increase, government and private insurance payers are seeking technological interventions. Technological solutions may provide high quality healthcare services at a distance, utilize professional resources more effectively, and enable elderly and ill patients to remain in their own homes. Patients may experience decreased hospitalization and urgent care settings, and out of home care may not be required as the patient is monitored at home. However, no study has been able to prove telehealth
While evaluating the face to face component of this category, two systemic reviews guided from meta-analyses were included. Both provided substantial, adequate feedback on the use of face to face monitoring or evaluation. Despite the evidence to support the frequent use of telehealth in the outpatient community, face to face monitoring with a physician or clinical specialist in the home does report a reduction in admissions a delay in admission if clinically inidicated (Qaddoura, Ashoori, Kabali, Thabane, Haynes, Connolly & Spall, 2015). All aforementioned studies evaluated heart failure patients with awareness of the pressing subject of heart failure readmission and the costly effect of lapses in outpatient care.
Telemetry monitoring has been proven to improve mortality in certain disorders where cardiac dysrhythmia is likely or possible (Dressler et al., 2014). However, studies
There are several forms of technology that is used to monitor, assist patients with self-care management, assist physicians with delivering care to their patients, including consultation with specialist, and overcoming barriers with transportation. “60% of the healthcare executives, physicians, and nurses in this inaugural survey said that telemedicine was a high priority for 2015“ (Vockley, 2015, para. 7) Telemedicine