• Jeydith Gutierrez, Jane Moeckli, Andrea Holcombe, Amy Mj O'Shea, George Bailey, Kelby Rewerts, Mariko Hagiwara, Steven Sullivan, Melissa Simon, and Peter Kaboli.
• VA Office of Rural Health (ORH), Veterans Rural Health Resource Center - Iowa City, Iowa City VA Healthcare System, Iowa City, Iowa.
• J Hosp Med. 2021 Mar 1; 16 (3): 156-163.

BackgroundTelehospitalist services are an innovative alternative approach to address staffing issues in rural and small hospitals.ObjectiveTo determine clinical outcomes and staff and patient satisfaction with a novel telehospitalist program among Veterans Health Administration (VHA) hospitals.Design, Setting, And ParticipantsWe conducted a mixed-methods evaluation of a quality improvement program with pre- and postimplementation measures. The hub site was a tertiary (high-complexity) VHA hospital, and the spoke site was a 10-bed inpatient medical unit at a rural (low-complexity) VHA hospital. All patients admitted during the study period were assigned to the spoke site.InterventionReal-time videoconferencing was used to connect a remote hospitalist physician with an on-site advanced practice provider and patients. Encounters were documented in the electronic health record.Main OutcomesProcess measures included workload, patient encounters, and daily census. Outcome measures included length of stay (LOS), readmission rate, mortality, and satisfaction of providers, staff, and patients. Surveys measured satisfaction. Qualitative analysis included unstructured and semi-structured interviews with spoke-site staff.ResultsTelehospitalist program implementation led to a significant reduction in LOS (3.0 [SD, 0.7] days vs 2.3 [SD, 0.3] days). The readmission rate was slightly higher in the telehospitalist group, with no change in mortality rate. Satisfaction among teleproviders was very high. Hub staff perceived the service as valuable, though satisfaction with the program was mixed. Technology and communication challenges were identified, but patient satisfaction remained mostly unchanged.ConclusionTelehospitalist programs are a feasible and safe way to provide inpatient coverage and address rural hospital staffing needs. Ensuring adequate technological quality and addressing staff concerns in a timely manner can enhance program performance.

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