The hospital otolaryngologist: The louisiana state university experience.

OBJECTIVES/HYPOTHESIS: To describe the implementation and impact of a hospital otolaryngologist in an academic medical center setting. Our hypothesis was that the hospital otolaryngologist would increase productivity of the Louisiana State University (LSU) faculty otolaryngologists and provide more timely access to inpatient otolaryngology services. STUDY DESIGN: Retrospective clinical and administrative database review. METHODS: A comparative database review was performed with data from the year predating the initiation of the hospitalist program (2013) to the first full year after initiation of the program (2014). A clinical database review including diagnoses and procedures was also performed. RESULTS: Overall outpatient clinic relative value units for the aggregated LSU faculty increased 16% (despite the fact that the direct outpatient contribution of the hospital otolaryngologist was negligible). Overall capture of inpatient consult codes increased 128%. The hospital otolaryngologist was responsible for 84.5% of inpatient consult codes. There was a 100% increase in outpatient consult codes for the LSU faculty, of which <1% was attributed to the otolaryngology hospitalist. No significant impact was seen on length of stay over the study interval. Clinical database review of the first 2 years of the program showed 3,707 total encounters with postoperative encounters the most common. Four hundred fifty-four inpatient procedures were logged. The most common surgical procedure was tracheostomy. CONCLUSIONS: The otolaryngology hospitalist program is a viable clinical and economic model. LEVEL OF EVIDENCE: NA Laryngoscope, 1851-1857, 2018.

Telemedicine-assisted neurotology in post-Katrina Southeast Louisiana.

OBJECTIVE: This study evaluates technical requirements, privacy and legal constraints, reimbursement considerations, and overall feasibility of a new telemedicine neurotologic patient care delivery model in post-Katrina, Southeast Louisiana. METHODS: This study is a retrospective review of the first year of a telemedicine neurotology practice with limited on-site neurotology physician availability (3-days monthly) with a full-time on-site audiologist, a full-time specialty-trained nurse practitioner, full-time neurosurgery on-site availability, and full-time otolaryngology on-site availability. RESULTS: A combined "store-and-forward" and "real-time" telemedicine delivery model was implemented for a new neurotology practice. Technical requirements include secure data transfer, real-time video-streaming, high-quality video otoscopy and microscopy, infrared video eye movement visualization and recording, remote visualization of radiologic imaging studies, and formalized diagnostic algorithms for patient evaluation. Telemedicine patient evaluations occur with the patient in Baton Rouge, LA, while the examining neurotologist is linked through a secure, commercially available communication connection in Pittsburgh, PA. Specifically designed consent forms and bilocation licensing and liability insurance coverage were required. Third-party payers were consulted before implementation to assure adherence to local reimbursement requirements. During the first 12 months of operation, 450 patient encounters were accomplished purely through telemedicine, with an additional 800 on-site patient visits and 150 operative procedures, including 24 neurotologic skull base procedures. CONCLUSION: Telemedicine is a viable delivery model for neurotology care delivery. Planning and implementation of such a model requires systematic considerations of medical, nursing, information systems, legal, reimbursement, and management parameters. Although the authors' initial motivation for this model was the resource-restricted, post-Katrina health care environment in South Louisiana, this delivery model has wider applicability in otolaryngology, other medical specialties, humanitarian outreach, and medical education. Prospective assessment of clinical outcomes and patient satisfaction is ongoing for objective validation of this delivery model.