1638. Tele-Infectious Disease Consultation Produces Equivalent Outcomes as In-Person Consultation
Session: Oral Abstract Session: Changing Clinical Practice for Changing Times
Friday, October 5, 2018: 3:00 PM
Room: S 157
Background: Technology can extend Infection Disease Consultants (IDCs) into resource limited small community U.S hospitals. We compared in-person infectious disease (ID) consults with Tele-ID consults to determine if length of stay, antibiotic usage, drug cost, or readmission rates will remain the same between both groups over a 3-month period.

Methods: University of Maryland Harford Memorial Hospital (UM-HMH) is a 95-bed hospital including a 6-bed ICU. From May – August 2017 (Study Period) there was no IDC at UM-HMH. During Study Period, IDCs from a regional UM hospital provided formal Tele-ID consults through a HIPAA compliant secured Skype Business account. Patient history and wound examination was done by the IDC via video monitor while a bedside nurse assisted in performing the physical exam. Lab and radiological data were reviewed in real time as both hospitals shared the same electronic medical record and IT infrastructure (Meditech 6.15). A formal consultation was dictated and computer orders were entered by the IDC within 24-hours of the consult request. Daily Tele-ID follow-up rounds were conducted. IDCs had the authority to transfer a patient to the regional hospital for in-person care if deemed necessary. Study Period was compared with a Baseline Period (May – August 2016) when IDCs were providing in-person consults at UM-HMH.

Results: Baseline Period had 148 inpatient stays and Study Period had 148 inpatient stays. Despite similar case mix index in both groups, there was no statistical difference between the clinical outcomes. Results are shown in table 1.

Baseline Period

Study Period

p value

Patients (n)

148

148

-

Average length of stay

6.7

7.1

0.54

Case mix index

1.16

1.23

0.46

Average days on antibiotics

5.9

6.2

0.47

Average drug cost

$484

$496

0.85

Readmission %

22.2

17.8

0.38

Deaths

3

3

1

Conclusion: Tele-ID at our hospitals was non-inferior to in-person ID consults. An integrated computer system, nursing support, and daily follow-up are key components of a successful Tele-ID program.

Faheem Younus, MD1, Leonardo Girio-Herrera, DO2, Fermin Barrueto Jr., MD1, Zaka Ahmed, MD3 and Paul Zimand, M.S.c.4, (1)University of Maryland Upper Chesapeak Health, Bel Air, MD, (2)Infection Prevention, University of Maryland Upper Chesapeak Health, Bel Air, MD, (3)University of Maryland Medical Center, Baltimore, MD, (4)University of Maryland Medical System, Baltimore, MD

Disclosures:

F. Younus, None

L. Girio-Herrera, None

F. Barrueto Jr., None

Z. Ahmed, None

P. Zimand, None

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