Purpose: The primary purpose of this quality improvement project was to decrease the time from referral to evaluation for stem cell transplant patients to < 30 days.
Background: Stem cell transplant patients referred to the VA Tennessee Valley Healthcare System (VATVHS) from throughout the U.S. require complex coordination of care, including travel and lodging at government expense. Coordination of care for this patient population was becoming labor intensive and inefficient. The prospect of travelling far from home for an extended evaluation creates an undue amount of stress and expense for some veterans. As the number of referrals increased, we sought methods to improve both the cost and efficiency associated with the referral process.
Methods: We implemented the videobased telemedicine evaluation system at VATVHS in July 2014. Our method for implementation involved the creation of a pretransplant evaluation template geared toward video-based telemedicine. Criteria for inclusion depended on the home VA’s ability to schedule and conduct video-based telemedicine. The attending physician assigned to the referral made the final decision as to whether the referred veteran was appropriate for video-based telemedicine or required an inperson evaluation. The time to evaluation from referral was our primary goal for improvement. Travel and lodging savings and reduction of clinic days were secondary measures of improvement.
Data Analysis: From July 9, 2014, to April 8, 2015, we evaluated 51 patient referrals using video-based telemedicine.
Results: We were able to decrease patient evaluation times from > 30 days to 19.4 days, a 35% reduction in time from referral to evaluation. Additionally, we were able to reduce air travel costs by $50,000 and lodging costs by $31,000. We were also able to decrease clinic days at VATVHS by 02 (2 patient clinic visits per evaluation).
Implications: Video-based telemedicine is an efficient, costeffective, convenient method of conducting initial evaluations for stem cell transplant patients. Further implementation of video-based telemedicine could serve to improve efficiency of evaluations, reduce the financial burden associated with travel and lodging, and serve to increase patient satisfaction by reducing travel time.
