In early 2023, if a patient living in rural Routt County, Colorado, was admitted to the UCHealth Yampa Valley Medical Center late at night, they may not have been seen by their inpatient physician until the next morning, or they were potentially transferred to another, farther away hospital to get care. Today, however, they would be able to stay at the medical center and instead get care virtually from a University of Colorado Medicine physician.
The change is due to a virtual hospitalist service line that was established through a partnership between the UCHealth Virtual Health Center and the Division of Hospital Medicine in the CU Department of Medicine. Under this service, a group of hospitalists (physicians who care for patients in hospitals) work remotely from 7 p.m. to 7 a.m. to cover the staffing needs of three UCHealth hospitals: Yampa Valley Medical Center, Pikes Peak Regional Hospital in Woodland Park, and Grandview Hospital in Colorado Springs.
“We wanted to better serve patients arriving overnight in some of these critical access and remote hospitals. These facilities are smaller, so staffing can be difficult overnight and result in a stretched-thin workforce. We were looking to fill that void,” says Adam Meyer, MD, an assistant professor and co-associate division head for the CU Division of Hospital Medicine.
Meyer helped launch the service in July 2023 and continues to oversee the service’s physician workforce and coordination with community hospitals, in partnership with the UCHealth Associate Chief Medical Officer for Virtual Health, Hemali Patel, MD. In the past year, the service has proven to be a valuable tool for patients and hospitals alike. As Meyer says, “It’s a win-win.”
“From the hospital standpoint, we’ve got a stable group of physicians who are providing inpatient coverage overnight. For nursing and ancillary staff, they know a physician is available to support them 24/7,” he says. “For patients, this service offers the ability to stay local. It’s a big ask for families to drive four hours into Denver or elsewhere to visit while their loved one receives care. Now, we can keep patients at their local facility and provide safe, quality care.”
The virtual service also allows an already stretched local hospitalist workforce to rest after a day shift, knowing all patients are cared for. This improves provider wellness and retention.
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Darlene Tad-y, MD, and Adam Meyer, MD, smile together outside of Pikes Peak Regional Hospital.
How it works
The idea for the virtual hospitalist service arose through the UCHealth Virtual Health Center, with the initial impetus coming from one of the three hospitals due to a need for physician staffing overnight, Meyer explains. Hospitalist Darlene Tad-y, MD, a professor of hospital medicine, initiated the service with the UCHealth Virtual Health Center, and she brought in Meyer to help launch and lead the service.
“We found there were two other facilities in the health system that could benefit from having additional physician support overnight,” he says about the selection of three hospitals to be involved in the service.
At the three facilities, there are hospitalists working in person during the day. At 7 p.m., CU hospitalists take over and remotely provide overnight cross-coverage.
“Patients who have already been admitted to the facility are handed off to us. For any patients who are admitted from the emergency room between 7 p.m. and 7 a.m., our virtual hospitalists will see the patient in real-time, virtually examine them, put in all necessary orders, and continue overseeing care until we hand off the patient to the daytime physician at 7 a.m.,” Meyer says.
To conduct this work virtually, the physicians and hospitals use a virtual platform that offers two-way video and examination capabilities, including a stethoscope, otoscope, and other tools that can be used to conduct remote exams.
“We’re basically filling a 12-hour gap where, in the past, it was often difficult to get real-time care once admitted to the hospital,” he says. “In addition, if a patient’s clinical status decompensates, we can provide rapid response and seamlessly facilitate a transfer for the patient to a higher level of care, if needed.”
Adam Meyer, MD, and Darlene Tad-y, MD, smile together outside of the Yampa Valley Medical Center.
Improving the access — and timing — of care
When launching this service, it was a challenge for some providers and hospitals to alter their typical processes and become comfortable with delivering care virtually.
“But I think once the change occurred, they realized the benefits far outweigh the change in how they were providing care,” Meyer says.
Since the program’s launch, Meyer estimates the remote hospitalists have helped hundreds of patients, typically cross-covering around 20 patients each night and conducting about 70 admissions per month between the three facilities.
“When we talk about access to care, it’s important to also talk about timing of care. Having a real-time evaluation is important because a patient may be admitted for one thing, but there are other factors that may come up when collecting the patient’s history and conducting the physical examination that need to be addressed,” Meyer says.
“We’ve heard of many cases where, if not for this service, a patient would have potentially been transferred out of the hospital or been admitted and not seen by a provider for many hours,” he adds. “Seeing the positive response from patients, families, nurses, and leaders at each facility about this virtual service — it’s been a great success.”
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Expanding the program
The virtual hospitalist service has grown over the past year to include new initiatives aimed at further enhancing the delivery of safe, quality care.
The first expansion was roughly six months ago, when the service started to support overnight employee exposures for the entire UCHealth system.
For example, if an employee was pricked by a needle, “through a virtual urgent care visit, our physicians evaluate the need for post-exposure prophylaxis, and we can prescribe that in real-time as needed,” Meyer says. “Typically, we see two employees a night.”
On July 1, the service expanded again — this time, beyond the nocturnal hours — to have a daytime virtual hospital physician serving in an administrative triage clinician role. In this role, the physician helps manage and direct all the hospitalist transfers into the UCHealth system, placing patients in a hospital with the appropriate capabilities and capacity.
“We have a lens on the capacity of each hospital, so we’re working to optimize transfers into and within the system so we can hopefully manage our capacity better,” Meyer says.
By doing this, the physician helps ensure the tertiary and quaternary referral centers are reserved for patients who have complex needs and require more advanced, specialized care while maximizing local hospitals’ capacity.
“For example, we don’t want to send a patient from Wyoming who has a simple pneumonia to the CU Anschutz Medical Campus when they could go to many other closer hospitals in the UCHealth system,” Meyer says.
Witnessing how the virtual hospitalist service has evolved in less than two years has been “really professionally satisfying,” Meyer says, with hopes of the program continuing to grow and enhance care in the future.
“On the horizon, I can see us potentially deepening that partnership with the Virtual Health Center and identifying additional opportunities to provide virtual models of care as hospitalists,” he says. “Going forward, I also see some additional opportunities for coordination and collaboration between hospitalists throughout our system, which is exciting because we can learn from one another and improve care of our patients.”
Ultimately, Meyer wants community members to know that the virtual hospitalist service still provides the same level of safe, quality care.
“Our hospitalists are well-trained. They have the breadth of experience to provide a high level of care to patients in other facilities,” he says. “And now, our patients get to stay local and be closer to their family and friends under this model.”
