Comparison of periodic in-person ID specialist care versus daily Tele-ID care via live audio-video visits and electronic consults
Target Population
Patients at a 164-bed community hospital in Armstrong County, Pennsylvania
Care Setting
Community hospital with limited access to in-person infectious disease specialists
Key Highlights
Daily Tele-ID care increased utilization of infectious disease specialist services compared to periodic in-person care.
Tele-ID patients had higher comorbidity scores but experienced shorter hospital length of stay and less frequent discharge on intravenous antibiotics.
No significant differences in in-hospital mortality or transfers to tertiary care facilities between Tele-ID and in-person groups.
Guideline-Based Recommendations
Diagnosis
Use live audio-video telemedicine visits and electronic consults to evaluate infectious disease patients remotely.
Employ trained local tele-presenter nurses to assist with physical examinations and telemedicine technology.
Management
Daily availability of Tele-ID services can facilitate earlier discharge and increased use of oral antibiotics.
Tele-ID physicians should determine the modality of consultation (live visit vs e-consult) based on patient complexity and resource availability.
Monitoring & Follow-up
Monitor hospital length of stay, discharge antibiotic route, readmission rates, and mortality to assess care quality.
Follow patients post-discharge with local community providers to ensure continuity of care.
Risks
Higher 30-day readmission rates observed in Tele-ID group, though ID-related readmissions were rare.
Ensure adequate training and support for tele-presenters to maintain examination quality.
Patient & Prescribing Data
Patients with infectious diseases requiring specialist consultation at a community hospital
Tele-ID patients were less likely to be discharged on intravenous antibiotics (34% vs 51%) and more likely on oral antibiotics (39% vs 23%), suggesting effective antimicrobial stewardship via telemedicine.
Clinical Best Practices
Implement daily Tele-ID services to improve access to infectious disease expertise in resource-limited community hospitals.
Utilize a multidisciplinary approach including tele-presenter nurses trained in telemedicine physical exams.
Tailor consultation type (live vs electronic) to patient complexity and local resource availability to optimize care delivery.
