Valley Regional Makes Connections

Valley News Staff Writer
Published: 12/9/2017 11:44:08 PM

Claremont — Help is now just the press of a button away for doctors and nurses in Valley Regional Hospital’s emergency department.

At 6 a.m. Thursday morning, the Claremont hospital launched a “tele-emergency” program. Now, when providers need assistance — if a particularly difficult case comes in or if a large number of patients come in at once and hospital staff are overwhelmed — they can activate the system and, within 60 seconds, doctors and nurses at Dartmouth-Hitchcock Medical Center (weekdays) or Sioux Falls, S.D.-based Avera eCARE (evenings and weekends) will appear on the screen attached to a wall facing the patient’s bed.

The remote providers can observe activity in the room — including the bedside monitor and vital signs — via a camera mounted above the screen. If, for example, a patient comes in suffering from a traumatic injury — which requires a doctor be very hands on — remote providers would likely observe and play a supporting role, such as assisting with documentation and helping to coordinate a transfer, Valley Regional’s CEO Peter Wright said. But, in the case of a heart attack, a remote doctor could direct on-site staff as they manage the patient’s care, he said.

In some instances, this extra help will allow patients to stay at Valley Regional and help keep the 396 beds at DHMC, a level-one trauma center in Lebanon, available for the region’s sickest people, said Wright. He helped present the new system during a media gathering in one of the two rooms now connected to the new service.

“This is about keeping people local,” he said.

Treating people closer to home means they are closer to their families and to follow-up care, Wright said. It’s also cheaper.

“The beds at Dartmouth-Hitchcock are really expensive and when we can’t treat them here, that’s where they go,” he said, later noting that more than 90 percent of Valley Regional’s transfers go to DHMC.

The beginning of tele-emergency services at Valley Regional is one example of D-H’s effort to assist community hospitals in caring for patients around the region. D-H provides tele-emergency services to eight other hospitals including three in the Upper Valley: DHMC, Mt. Ascutney Hospital and Health Center in Windsor and New London Hospital.

Tele-emergency is just one of a suite of services D-H now offers for a subscription fee, which Dr. Kevin Curtis, the medical director of D-H’s Connected Care program, declined to disclose at the event on Thursday. Other such services include tele-intensive care, tele-pharmacy, tele-neurology, tele-psychiatry and a range of non-acute medical specialties.

“We’re constantly thinking about how can we work with the bedside teams, with hospitals and with communities to bring resources and specialists to where they are,” said Curtis, an emergency medicine physician.

About one-third of the patients that D-H helps care for through it’s tele-emergency program stay at the community hospital where they are being treated, Curtis said. In the two or so years the program has been active, D-H has seen more than 600 tele-emergency patients, he said.

When patients do need to be transferred elsewhere, the tele-emergency providers can help arrange the move, both Wright and Curtis said.

Tele-emergency “improves the process and improves the transition of care,” Wright said. “That’s the gap. That’s where patients tend to get lost in the system. This does a much better job at closing those holes.”

Valley Regional’s director of emergency services, Jenn Ranney, a registered nurse, said the tele-emergency nursing services will help the hospital’s nurses to focus on patient care, while the remote nurses observe and document that care. It will also help nurses to treat patients who come in with conditions Valley Regional staff have never seen before, she said.

Like many small hospitals around the country, Valley Regional does not have cardiologists, neurologists, pulmonologists and other specialists on-call at all hours of the day, Wright said. By helping guide staff through the treatment of difficult or unfamiliar cases, the tele-emergency service will help Valley Regional staff grow their skills, he said.

In order to prepare for Thursday’s launch, Ranney said, she told D-H staff where all the supplies are located in Valley Regional’s emergency rooms. She also provided descriptions of the supplies and equipment they have on hand, including brand names, so the tele-health providers can offer specific and relevant instructions.

An extra set of hands, particularly on the night shift, will be very helpful, she said.

“From a nursing perspective, this is huge,” she said.

While this is Valley Regional’s first step into the world of tele-health, at least one other Upper Valley hospital has ventured further into this field. The White River Junction VA Medical Center celebrated the beginning of its tele-intensive care program — a partnership with Cincinnati VA Medical Center/Veterans Integrated Service Network, late last month. The White River Junction VA also offers a wide range of services including clinical as well as home tele-health programs, such as smoking cessation, diabetes, hypertension and weight loss.

Looking to the future, Wright pointed to the possibilities for tele-health to benefit patients beyond the hospital’s walls.

“The real advancement I see is prevention,” Wright said.

For example, if providers can monitor patients’ blood sugar and blood pressure remotely and identify when they’ve reached a threshold of concern, providers may be able to intervene before a patient needs to make a trip to the emergency room, he said.

The broader issue of the rising cost of medical care nationally will not be solved simply by preventing a patient from going from a community hospital to an academic medical center, he said.

“The issue is really not having them get here,” Wright said.

Valley News Staff Writer Nora Doyle-Burr can be reached at or 603-727-3213.

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