About Customer

Allen Hospital is a 204-bed not-for-profit community hospital located in Waterloo, Iowa. The hospital cares for more inpatients, outpatients, emergency and cardiac patients than any other in its 10-county service area. Allen is affiliated with UnityPoint Health, which cares for one out of every three patients in Iowa and is the state’s largest health system. Allen Hospital added virtual behavioral health services to its emergency department in response to strained staffing resources and a growing population of patients with mental health needs. The result was a domino effect that reduced length of stay, improved throughput in the emergency department, and created an annual ROI for the hospital of 281%.

The Challenge

Allen Hospital was facing an increasingly difficult challenge caring for behavioral health patients. The hospital had a 21-bed inpatient behavioral health unit and one full-time psychiatrist. In the surrounding community there was often a 3-month wait for an outpatient psychiatric visit—thus many patients turned to the hospital for care. The demand for behavioral health evaluations was continually overloading the hospital’s resources.

In the emergency department (ED), where the problem was at its most acute, patients who required behavioral health evaluations faced extended wait times. Like many community hospitals throughout the country which face similar challenges, these patients were often boarded in hallways, or scattered in rooms throughout the ED while they awaited evaluations.

Increased wait times meant patient dispositions were not being met in a timely manner. The lack of resources and specialized psychiatric expertise led to longer boarding times thus increasing patient agitation.

The hospital’s resources were also stretched thin on the inpatient side. Allen had one locum psychiatrist and additional locums were repeatedly burning out. The psychiatrists often could not get around the hospital for all the consults necessary within 24 hours. Hospital leadership knew that Allen had to make a change.

The Solution

Allen’s solution was three-pronged:

1. A new investment in on-site behavioral health consultants and psychiatric safety techs.
2. A physical reorganization of the ED.
3. A partnership with Access TeleCare to provide both emergency and inpatient virtual behavioral health consults.

First, Allen formed a behavioral health response team, comprised of on-site behavioral health consultants and psychiatric safety techs.

Next, the hospital reorganized the space in the ED, sectioning off one hallway and its adjoining rooms to serve as an emergent behavioral health unit. The new unit includes five rooms, all ligature-free, and a crisis observation area.

Finally, to close the gap on the shortage of clinical resources, Allen partnered with Access TeleCare to provide virtual behavioral health consults, both in the emergency department and in their med-surg units.

““Our successfulpartnership with AccessTeleCare at Allen Hospitalshowed that we couldhelp alleviate the stressplaced on our otherfacilities. Access TeleCareis a helpful moralebooster to our doctorsand nurses while alsoproviding best-in-classcare for our patients.””

– Calvin Heller
Director, Telehealth
UnityPoint Health

Results

An analysis by Access TeleCare and UnityPoint Allen showed dramatic results:

• When comparing the 12 months prior to beginning virtual behavioral health services to the 21 months following, ALOS for mental health patients fell 11.87 hours.
• At an average cost to the hospital of $62 per boarding hour, Allen avoided more than $1.7 million in annualized boarding costs.
• Taking into account the investment in the Access TeleCare program over that same time period, Allen Hospital saw an annual return on investment of 281% based on reduction in boarding patients.

Both the patient and provider experience is also much improved and ED throughput improved overall. The effects are also being felt outside of the emergency department. The changes reduced the admission rate by 4%, and the time it takes to do consults has plunged dramatically, down to 2-3 hours per day. Also, with Access TeleCare’s assistance with night and weekend coverage, the hospital faces less burnout from its onsite clinical resources. The hospital’s emergency physicians and nurses are now more available to focus on other patients, resulting in the average length of stay for the emergency department as a whole to decrease by 66 minutes.

The Result and Key Outcomes

The teleICU program improved ICU care and financial performance across the board:
• 15 percent reduction in patient transfers, and retention of 144 additional patients annually
• $1.18 million in added revenue and $594,000 in annual profit
• 4-percent increase in Case Mix Index, generating $442,000 in additional profit
• 257 percent estimated ROI

Nursing skills and confidence with high-acuity care also improved. A distinguishing feature of Access TeleCare’s virtual ICU model is providing ongoing coaching and clinical education for on-site clinicians. Eighteen months in, the CNO reported significant gains in both capability and confidence among the care team.

“The Access TeleCare intensivists actually teach and coach our nurses. They discuss why they think it is best to order certain medications or recommend various clinical interventions. That teaching has really elevated the knowledge level of the team.” – Hospital CNO