Inpatient Telehepatology at Community Hospitals: Expanding Access and Comanaging Complex Care

Area of Science:

• Hepatology
• Telemedicine
• Healthcare Management

Background:

• Decompensated liver disease often requires transfer to tertiary care hospitals (TCHs), leading to delays and potential medical errors.
• Wait lists at TCHs for patient transfers can impede timely access to advanced liver care.
• Managing complex liver disease necessitates specialized expertise often concentrated in academic health centers (AHCs).

Purpose of the Study:

• To evaluate the logistics, feasibility, and outcomes of a remote inpatient telehepatology (INP-TH) consultation service.
• To reduce the need for patient transfers to AHCs by enabling local comanagement of advanced liver disease.
• To assess the impact of INP-TH on patient care, provider satisfaction, and healthcare resource utilization.

Main Methods:

• Implementation of an INP-TH service at three community hospitals within a health system.
• Utilized existing clinical staff and patient-facing iPads for virtual consultations.
• Involved AHC-based hepatology physician assistants and attendings for INP-TH consultations.
• Excluded patients in the ED or ICU from INP-TH requests.

Main Results:

• Successfully comanaged 143 out of 155 (92%) patients locally, with only 12 (8%) requiring transfer to the AHC.
• Achieved 57% outpatient hepatology follow-up within 30 days post-consultation.
• Reported a 30-day readmission rate of 28% and a 30-day mortality rate of 8% (13 deaths).
• Demonstrated high provider engagement and satisfaction from both hepatology teams and hospitalists.

Conclusions:

• Remote inpatient telehepatology is a feasible and effective model for comanaging patients with decompensated cirrhosis at community hospitals.
• The INP-TH service significantly reduces the need for physical patient transfers, improving access to specialized care.
• This model offers a scalable approach to enhance care for complex liver diseases across integrated health systems.