New hospital telemedicine services: potential market for a nighttime telehospitalist service

Abstract

Background: A critical shortage in the supply of physicians in the United States has necessitated innovative approaches to physician service delivery. Telemedicine is a viable service delivery model for a variety of physician and health services. Telemedicine is most effective when applied where physician resources are scarce, patient care is time sensitive, and service volume may be distributed across a network. Shortages in critical care and neurology specialists have led to the use of tele-intensive care unit and telestroke services in hospital settings. These hospital-based telemedicine services have gained acceptance and recommendation. Hospitalist staffing shortages may provide an opportunity to apply similar telemedicine models to hospitalist medicine. This study assesses the potential market for a nighttime telehospitalist service.

Materials and methods: An analysis of the Florida state hospital discharge dataset investigated the potential market for a new nighttime telehospitalist service. Admissions were filtered and stratified for common hospitalist metrics, time of day, and age of patients. Admissions were further expressed by hour of day and location.

Results: Nineteen percent of common hospitalist admissions occurred between 7:00 p.m. and 7:00 a.m., with a range of 17%-27% or 0.23-10.09 admissions per night per facility. Eighty percent of admissions occurred prior to midnight. Nonrural facilities averaged 6.69 hospitalist admissions per night, whereas rural facilities averaged 1.35 admissions per night.

Conclusions: The low volume of nighttime admissions indicates an opportunity to leverage a telehospitalist physician service to deliver inpatient medical admission services across a network. Lower volumes of nighttime admissions in rural facilities may indicate a market for telehospitalist solutions to address the dilemma of hospitalist staffing shortages.

Keywords: business administration/economics; commercial telemedicine; telehealth; telemedicine.

Fig. 1.

Percentage of hospitalist admissions in all facilities analyzed by shift, reflecting peak times for admissions in short-shift blocks (7:00 a.m.–3:00 p.m./3:00 p.m.–12:00 a.m./12:00 a.m.–7:00 a.m.) and 12-h shift blocks (7:00 a.m.–7:00 p.m./7:00 p.m.–7:00 a.m.).

Fig. 2.

Percentage of hospitalist admissions in rural facilities by shift, reflecting peak times for admissions in short-shift blocks (7:00 a.m.–3:00 p.m./3:00 p.m.–12:00 a.m./12:00 a.m.–7:00 a.m.) and 12-h shift blocks (7:00 a.m.–7:00 p.m./7:00 p.m.–7:00 a.m.).

Fig. 3.

Assumed hospitalist admission volume per hour at all rural facilities analyzed. This represents a cumulative volume of admissions in each hour segment and not a per-day or per-facility volume.

Fig. 4.

Comparison of admissions per shift between rural and nonrural facilities analyzed by shift, reflecting short-shift blocks (7:00 a.m.–3:00 p.m./3:00 p.m.–12:00 a.m./12:00 a.m.–7:00 a.m.) and 12-h shift blocks (7:00 a.m.–7:00 p.m./7:00 p.m.–7:00 a.m.).