HospitalInspections.org

Based on interview and record review, the facility failed to have the Governing Board (GB) ensure the written agreement between the hospital and telemedicine intensivist physician group's (Telehealth group) expanded services of covering non-critical care inpatient hospital units during the night shift. This failure had the potential for poor patient outcomes when hospital staff had no guidance or clear instructions for how contacting and/or interacting with the Telehealth group to obtain medical interventions and/or orders.

Findings:

During an interview, on 3/20/24 at 10:20 am, Office Coordinator 1 (Coordinator 1), stated that starting 3/1/24, the Hospitalist (a dedicated physician who works exclusively in a hospital) service on night shift was now covered by a remote Telemedicine group. Coordinator 1 stated, that it was the same group that covered the ICU. Coordinator 1 stated that one Telemedicine Doctor worked the night shift, from 7pm to 7am, and supervised two on-site facility Residents (a medical school graduate with a Doctor of Medicine (MD) degree who is taking part in a post-graduate training program). The Telemedicine Doctor was able to view and assess patients with the assistance of a Resident, through cameras and telehealth computer software. Coordinator 1 stated that the remote Telemedicine Doctor must electronically co-sign every order and progress note a Resident entered for a patient at the facility. Coordinator 1 stated, "they supervise the two residents."

During an interview with RN Manager 1 (RN 1) on 3/20/24, RN 1 stated that Residents were now supervised by a Telehealth Group doctor during night shift. RN 1 also stated during patient emergencies, an Emergency Room doctor came to the hospital units to assist Residents and perform invasive procedures (A medical procedure that enters the body, usually by cutting or puncturing the skin or by inserting instruments into the body) since the Telehealth Group doctor was not physically present.


During a review of facility's contract titled, "Telehealth Critical Care Professional Services Agreement", dated 5/1/20, it indicated an agreement between the facility and Telehealth Group. The contract read, "[telemedicine] Group shall provide Qualified Physicians to provide critical care telehealth services for 24 hours a day, 7 days per week ...." The contract also outlined the term length of services contracted, "This Agreement shall commence on May 1, 2020 ("Effective Date") and shall continue for a period of two (2) years, unless earlier terminated as provided in this Agreement. The Agreement will renew automatically for one (1) year terms unless terminated by either party in accordance with this Agreement. The Agreement may be modified upon mutual written agreement of the parties hereto. "The contract further indicated, "Any amendment to or modification of this Agreement shall be in writing, signed by [both parties] indicating the actual date signed, and attached hereto."

During an interview with Facility Chief Executive Officer (CEO) and three doctors (MD 1, MD2, MD3) on 3/26/24, the CEO and MD 1 verbally confirmed that the remote Telehealth group was now covering non-critical in-patients at the hospital during night shift. CEO and MD1 both stated that a new contract had not been created for the expanded new services. MD 1 also stated all Telehealth group doctors were privileged (when a facility gives credentials to a doctor to work and provide care there) by the facility to provide care to any patient.

During an interview with a Telehealth Group Representative (Telehealth Rep 1) on 4/4/24, Telehealth Rep 1 stated, "We went live covering [the facility's] ICU during the pandemic, roughly February 2021. That originally went until May 2022. Our services were paused in May 2022. The facility went back to us in March 2023, and reinstated services with us." Telehealth Rep 1 also stated that Telehealth Group had other fields of service they provided, but that they (Telehealth group), "only has contract services for ICU at this time, only critical care." Telehealth Rep 1 stated that Telehealth Group did not have a new contract with Facility to include expanded Hospitalist coverage services, and that a new updated contract has not been opened or talked about.