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Telemed J E Health. 2010 Apr;16(3):299-305. doi: 10.1089/tmj.2009.0115.

Tele-assistance in chronic respiratory failure: patients' characterization and staff workload of 5-year activity.

Author information

1
Pneumology Division, Salvatore Maugeri Foundation, IRCCS, Via Giuseppe Mazzini 129, Lumezzane, Brescia, Italy. michele.vitacca@fsm.it

Abstract

BACKGROUND:

The issue of how to optimize the routine use of tele-assistance (TA) in the clinical care remains to be addressed. Skills and costs of human resources represent the major component to care for chronic patients with TA.

METHODS:

We investigated (1) the change in patient population, mortality, and staff utilization/cost during the first 5-year activity of a TA program (24-h availability of a call center, pulse oxygen device, and second medical opinion) dedicated to chronic respiratory failure patients and (2) the staff time dedicated to each new patient admitted to the service.

RESULTS:

Three-hundred and ninety-six patients (age 64 +/- 17 years; 296 men) were reviewed across 5 years of activity. Patients followed/year increased over time, particularly for amyotrophic lateral sclerosis subjects. Calls/month dramatically increased from 60 to 290, with a 5-year number of calls equal to 12.952. The doctor's time dedicated to TA decreased over time, whereas the nurse's time increased allowing a cost saving of 39% when compared with budgeted salary costs. The number of home ventilated patients did not change, remaining over 78%. The mortality rate increased over time (from 6% to 11%). Both chronic obstructive pulmonary disease (COPD) and No-COPD patients used the TA service more frequently during the winter, and COPD used it also in the summer.

CONCLUSIONS:

A stable TA service dedicated to chronic respiratory failure may be reached after 4 years. Across years, (1) number of patients increased, with COPD and ventilated subjects being the most representative; (2) calls varied during seasons; (3) doctor's workload decreased, saving salary costs; and (4) each new enrolled patient may require 73 and 27 min/month of nurse and doctor, respectively.

PMID:
20406117
DOI:
10.1089/tmj.2009.0115
[Indexed for MEDLINE]

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