Staffing for urgent care sites has always been a challenge at Baptist Health, which is headquartered in Louisville, Kentucky, and serves that state and Indiana.

THE PROBLEM

Staff at Baptist Health can look at prior patterns but still struggle at times to predict correctly for specific days and times. Further, with today's healthcare staffing challenges, even if Baptist Health recognizes a need for extra workers, it may not have the resources to upstaff appropriately.

"Our urgent care centers' wait times and, hence, patient experience can be greatly impacted by these unpredictable ebbs and flows in patients presenting," said Dr. Brett A. Oliver, chief medical information officer at Baptist Health. "This is especially true the last hour or so before the close of a clinic.

"In fact, we had one urgent care in our Hardin market have a competitor urgent care change their hours to close at an earlier time, increasing the volume even more at the end of the day in our location," he continued. 

"This influx of patients leads to long wait times, which is not good for patients, but also requires providers and staff to stay late, which is not good for their experience and could lead to increased expenses on the health system."

Since the health system could not add staff, providers or additional exam rooms, it needed to find ways to increase throughput and provide patients the quickest and most appropriate form of clinical care possible.

PROPOSAL

The proposal was to have a standalone video visit kiosk within the urgent care locations to offer patients with lower-acuity problems an alternative to the longer wait for being seen in person.

"As patients arrive and their chief complaint is on a pre-approved list of problems that could be seen virtually, front desk staff simply offer them options," said Nick Sarantis, system director of digital health at Baptist Health. "For example, staff would say, 'Our current wait time is about 90 minutes; however, with your current complaint, we do have a virtual option and the virtual provider can see you right now.'

"If the patient chooses the virtual option, they are walked back to the self-service kiosk, log into their MyChart account on the tablet, and be placed in line with our group of virtual urgent care providers," he continued. "These virtual providers are centralized in our system and prior to the urgent care rollout already were available 24/7 for other virtual care needs."

"Where else could you receive a healthcare service with a wait time of only six minutes, especially as a walk-in patient?"

Dr. Brett A. Oliver, Baptist Health

With this robust telemedicine device, from vendor TytoCare, the visit is more than a simple video connection. The virtual provider is able to listen to a patient's heart and lungs, look in their ears and throat, and examine their skin and eyes. This is a big advancement over the traditional video visit.

"When our virtual care providers see 'TytoClinic' on their schedules, they immediately move them to the top of the queue since these are patients waiting at an urgent care location versus patients waiting at their own homes," Sarantis explained. 

"Having the ability to provide patients a faster option to be seen pleases the patient, as well as decreases the amount of time providers and staff have to remain on site, on the clock."

MEETING THE CHALLENGE

The TytoClinic allows for patients to be seen virtually versus waiting for a long time in person. It also exposes patients to a technology they can do at their own homes if they suffer from a similar issue in the future.

"Patients who use the TytoClinic system, which is integrated into our Epic EHR, login to their MyChart account and the virtual urgent care providers connect to that patient via their Epic schedule," Oliver said. "Documentation is done via Epic, as well. No scanned documents.

"The virtual urgent care note files into Epic just like they were seen in person for other caregivers to be able to review," he added. "The convenient thing is if the virtual care provider determines the patient needs a higher level of care, they can simply be transferred over to the in-person provider at that location."

RESULTS

In the eight months since implementation, Baptist Health has had approximately 1,700 TytoClinic visits from urgent care locations. The median wait time has been only six minutes.

"Where else could you receive a healthcare service with a wait time of only six minutes, especially as a walk-in patient?" Oliver asked. "We are very pleased with how patients have taken to this option and how some of our busier clinics have used the technology."

One patient comment Oliver reported: "I am visiting urgent care for flu-like symptoms. Barbi introduced me to the virtual visit. I just wanted to say how much I liked this way. I feel I got the same level of care as a face-to-face visit. Everyone was still very professional, even though I spoke to the doctor on a screen. Thank you all for seeing me this way."

Following this success, Baptist Health decided to pilot a TytoClinic device in all of its primary care offices in one of its markets.

"This is a generally more rural market where sending someone to an urgent care could mean driving an hour or more," Oliver explained. "By adding the device to these offices, we have in many ways added an urgent care location for patients in these neighborhoods. We're excited to see about the improved access we will be providing in these underserved areas."

ADVICE FOR OTHERS

For peers looking to run a similar telemedicine program, Oliver and Sarantis encourage them to stay engaged with operational partners throughout the implementation.

"It was really through listening to the operational challenges in our urgent care settings that we were able to offer this solution," Sarantis noted. "This strong partnership has truly benefited our patients and staff alike.

"Putting in the technology is the easy part, but the change management to implement an entirely new workflow will take lots of communication and follow-up," he concluded. "To help maintain the comradery and communication post go-live, our digital health team sponsored a pizza party contest for the urgent care clinic that had the most telemedicine visits in a month."

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