Date of Conferral

2021

Degree

Doctor of Nursing Practice (DNP)

School

Nursing

Advisor

Robert McWhirt

Abstract

Critical access hospitals (CAHs) encounter unique challenges in terms of providingquality resources to their community, often lacking quality measures and continuity comparable to larger regional and tertiary hospitals. One CAH in rural Minnesota implemented an overnight hospitalist telemedicine service to address concerns with provider resources and quality practice. An evaluation of quality improvement implementation was completed to address data regarding ER transfers and inpatient length of stay (LOS). Following the triple aim framework to improve patient care, population health, and decrease costs, Donabedian’s model of quality improvement was utilized. Three months of pre and postimplementation data were collected one year apart using the organization’s EPIC ER transfer data and BI Launchpad software for inpatient LOS. Data were analyzed using Chi square and t-test. Chi Square test did not show statistical significance (p = 0.296) between pre and post intervention ER transfer. LOS data among adult inpatients (18 years and older) also showed no significance, with p = 0.081 during preintervention (n = 82) and postintervention (n = 86). Although no statistical significance was found involving ER transfers and LOS with this evaluation, literature supports continued investigation involving hospitalist telemedicine. Ongoing staffing and resources in rural underserved areas provide unique challenges. Using technology such as telemedicine at scale is one way to address this issue in service of positive social change.

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