Evaluation of Nurses' Intention to Use After-hour Skilled Nursing Facility Telemedicine-enabled Physician Coverage Service: An Evidence-based Practice Project
Evaluation of Nurses’ Intention to Use After-hour Skilled Nursing Facility Telemedicine-enabled Physician Coverage Service: An Evidence-based Practice Project Diane Rose Croll, DNP, APRN, FNP-BC Director: Janice Agazio, PhD, CRNP, FAANP, FAAN There is a significant number of unnecessary rehospitalizations of post-acute patients from skilled nursing facilities (SNF). Many of these transfers occur after hours when onsite practitioners are not available. Care is often delegated to telephonic medical coverage which may be ineffective. The acuity level of patients being admitted to SNFs is increasing. An increased presence of medical practitioners is needed to provide safe, effective care at all hours for higher acuity level SNF patients. An after-hours telemedicine-enabled physician coverage service meets the need for additional practitioner presence. In some instances, nurse utilization of the service is limited. The purpose of this project is to ultimately improve utilization of a telemedicine-enabled after-hours coverage service of SNF patients and reduce unnecessary hospitalizations. The PICOT questions for this project were: 1) What barriers affect a nurse’s intention to use an after-hours telemedicine-enabled physician coverage service intended to reduce rehospitalizations in SNFs over a three-month period? 2) Is there a correlation between intention to use the service and service utilization? Project design was an evidence-based project that utilized quantitative data. The project method involved introducing nurses to the service through a telemedicine-enabled training session. Demographic data were collected and an anonymous modified UTAUT questionnaire was completed at the initial session and approximately four weeks later. Utilization data were obtained from the service’s electronic records. Analysis of the data revealed that there was a statistically significant decline in the intention to use the system scores between the first and second sessions with the level of intention changing from “probably” to “neutral”; however, there was increased utilization between the same time periods in two of the three facilities. In the months following the project, utilization increased significantly and often exceeded average service-wide utilization. It is concluded that the UTAUT questionnaire did not appear to provide accurate evaluation of the intention to use the service in this setting. In spite of this finding, information gathered from the project can be used to improve the nurse training program.
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