By: Dr. Tom Sequist

Tags: uniform high quality

This is the fourth article in an ongoing series by our Quality, Safety & Value team highlighting Partners HealthCare’s efforts to develop and implement best practices across our network of hospitals to improve the quality of care patients receive while reducing costs.

Across the United States and within Partners HealthCare, thousands of patients are discharged from an acute hospital to spend time at a rehabilitation hospital. Our patients often have complex medical needs due to illnesses such as burns, bone fractures or heart injuries. Staying at the rehabilitation hospital gives our patients more time to get stronger and be safer to go home. Sometimes this recovery can take weeks or even months.

While still staying at the rehabilitation hospital, many of these patients have to travel back to their doctor’s office for regular follow up appointments. This allows their original doctors from the acute hospital to make sure that the healing process is successful and avoid any possible complications.

However, it is hard to get patients from the rehabilitation hospital to their doctor’s office, and then back to the rehabilitation hospital. Many patients are still weak, and often cannot walk on their own. An ambulance ride is usually needed. This whole process can take up to five hours – so that patients can spend 15 to 20 minutes in the appointment with their doctor. Each of these trips can cost the health care system hundreds of dollars. But more importantly, they cause a lot of discomfort for patients and their families.

A new telemedicine program started in 2013 between Spaulding Rehabilitation Hospital and Massachusetts General Hospital (MGH) is changing all of this.

How Telemedicine Is Transforming Rehabilitation

Telemedicine is a way to connect doctors and patients at different locations using advanced technology like live video connections over the Internet. Using telemedicine, doctors and patients can have conversations and do physical exams that lead to treatment recommendations. These “telemedicine” programs can improve health outcomes and experiences for our patients – and at the same time, lower costs.

We are using telemedicine to connect our patients at Spaulding with their original physicians at MGH. Patients and their families love the program. Patients avoid the two-mile, crowded inner city ambulance ride and the wait-time at the hospital for their appointments. They no longer have to interrupt their therapy or medication routine at Spaulding. Patients’ families also participate in the virtual appointment, either from the patient’s room at Spaulding, or even from their own home using an Internet connection.

One Patient’s Experience

Telemedicine can be particularly useful for patients experiencing severe burns. These patients often spend a month in the acute hospital, and need at least another month in the rehabilitation hospital to recover. One of the earliest patients to benefit from our telemedicine program had suffered burns to 80 percent of his body in an explosion at home.

After being treated by the burn team at MGH, the patient was transferred to Spaulding Rehabilitation Hospital. During his 39 days at Spaulding, he needed daily physical and occupational therapy to have a successful recovery. He was making progress every day. If telemedicine had not been an option, the patient would have missed a full day of physical therapy at least once per week for his follow up appointments at MGH.

As the patient described it:

I definitely feel that my virtual visits helped me get out of Spaulding at least a week earlier. The convenience of being able to stay at Spaulding and still be in contact with my Massachusetts General doctors was huge. It was just like talking to my doctor face-to-face. The doctor had the equipment to look at me, see the parts he needed to see, and make the decisions he needed to make to treat me. It was a great experience.

The patient’s providers at MGH also felt the experience was a positive one, as his physician described:

Not only has it saved a huge amount of time and inconvenience for the patients, but it has done a lot to strengthen the relationship and communication between the burn unit and people caring for the patients at Spaulding. It’s led to a higher level of coordination and collaboration between our teams and our patients really feel like they're still closely being followed by their burn surgeons during their rehabilitation.

Avoiding Hospital Readmissions

No one wants to be readmitted to the acute hospital – that is usually a step back in recovery, often caused by some complication in the healing process. With close medical attention, readmissions can often be avoided. Since the telemedicine program started, we have successfully reduced readmission rates from Spaulding back to MGH for burn patients from 7 percent in 2013 to 0 percent in 2014 and 2015.

Expanding the Telemedicine Program and Our Future

After the success of the burn program, the telemedicine program between MGH and Spaulding now includes plastic surgery, cardiology, neurology and urology. We are growing quickly – since 2013, 150 patients have been enrolled, including 50 patients already in 2015. We are now working to expand this program across other Partners hospitals, including Brigham and Women’s Hospital.

We are working hard to ensure that our patients receive the highest-quality care possible. This means that we need to coordinate care across all of our institutions, especially for our most complex patients. Over the next 1-2 years, our entire system will use the same electronic health record. This will make it even easier for patients to receive seamless, well-coordinated care across Partners.

Read our last post in the Higher-Quality Care series on treating depression.