Remote Presence Timely Discharge Management

Reduction in beds coupled with the increased need for health care services has led to a
supply and demand struggle or capacity management challenge for health care facilities.
This is now recognized as a major public health issue. The impact is readily seen as
overcrowding in emergency departments. At present 76% of hospitals' emergency departments
(ETDs) are at or over capacity with 33% reporting ambulance diversions, the most common sign
of overcapacity within a health care facility. Compounding the physical capacity problem is
the "human capacity strain" as admitted patients remain in the ETD for prolonged periods
waiting for beds. Delayed admission to patient care units significantly strains the
financial resources, impedes "patient flow" ultimately impacting the quality of care,
patient satisfaction and the "bottom line." Discharge before 11 am optimizes the
availability of hospital beds to meet admission demands thereby avoiding a surge over
capacity or "patient back log", ambulance diversions in ETD; the post anesthesia recovery
unit, admissions office and critical care units. Conversely competing needs for the
attending physician's physical presence off of the hospital premises; off of the unit
(private practice and meetings) often delays patient discharge from before 11 am to the
afternoon and evening.

Inclusion Criteria:

- Adult patients

- Primary care physicians in internal medicine

- Primary care physicians/practice group with established discharge pattern after 11 am

- Primary care physicians/practice group with fast access digital subscriber line (DSL)
300 kilobytes per second

- Primary care physicians/practice group who have Hackensack Medical Center (HUMC)
intranet access from pre-determined location

Exclusion Criteria:

- Non-English speaking patients

- Patients requiring acute level of care on the day of discharge