Table 2.

GERI-PaL Response-Specific Outcomes, Rationale, and Implementation

GERI-Pal Response	Facilities Contacted	Facilities Implemented	Rationale	Implementation
Rapidly establishing telemedicine consultation	2	2	•All parties recognize urgent nature of contract negation	•Accelerate (48 h) contract approval with legal team; can initiate consultation during contract finalization phase
			•Facility LIP may not be available to be on-site to assess residents or provide care (due to illness, quarantine, or health risk)	•Provides “on-site” care available to participating facility LIPs with limited or no ability to enter facility
			•Complex decision making required for anticipated changes to clinical care and PPE prior to PPS	•Facilitate cohorting plan for residents and staff
			•Ensure appropriate technology and training on-site prior to clinical engagement	•Medical center telehealth technical team can deliver tablet computer with linked handheld examination kit and application to facility
			•Ensure appropriate training of facility staff with technology and new role of “tele presenter”	•Nurse liaison trains facility “super user” in detail and other staff members as needed
Virtual daily rounding on facility residents	2	2	•Dedicate time for all stakeholders to efficiently make clinical decisions	•Facility staffing and vital sign gathering dictates timing of rounds
			•Facility LIP participation is critical for implementation	•Ensure resident primary LIP invited to actively participate in rounds—start with discussion of their patient(s)
			•Consolidated timing supports LIP participation	•Facility dictates preferred way to contact LIPs
			•Ensure HIPAA-compliant, secured online platform for remote clinical discussion	•HIPAA-compliant teleconferencing can be provided by academic medical center
Updates of patients admitted to the hospital	2	2	•Facility staff often not updated with hospital course of their residents	•Telemedicine team serves as point of contact for facility communication with hospital
			•Facility staff limited in communication with residents' families	•Notify staff of in-hospital mortality
Facilitated transfer to hospital	2	2	•Facility may have multiple residents needing hospital transfer in coordinated effort with transportation and accepting hospital	•Telemedicine consult team can assist with directly admitting patients if seen “virtually” by consulting physician who is also hospital physician
			•Hospitals and EMS concerned with unpredictable surge	•Telemedicine consult team in continuous communication with facility about residents with clinical decline, to notify hospital with anticipated transfers in next 24-48 h
Facilitated transfer from hospital	2	2	•Facility often not aware of upcoming hospital discharges until imminent	•Telemedicine team follows daily hospital course to help anticipate potential discharge days prior
			•Facilities with staffing limitation may limit number and timing of readmissions	•Telemedicine team communicates when and number of residents facility can accept based on anticipated staffing

EMS, Emergency Medical Services; HIPAA, Health Insurance Portability and Accountability Act.