Value-Based Approach to Overnight Nursing Teleconsultation in Rural Small Long-Term Care Centers: Mixed-Methods Study (Preprint)

BACKGROUND Accelerated aging of the population and the growing prevalence of chronic diseases are increasing the demand for long-term care in Quebec, Canada. In rural and remote areas, ongoing overnight nursing shortages compromise the continuity, quality, and safety of care in residential and long-term care centers (“Centres d’hébergement et de soins de longue durée”; CHSLDs). In this context, nursing teleconsultation is emerging as an innovative approach to providing real-time clinical support, strengthening decision-making, and optimizing resource utilization. However, empirical data on its implementation and added value in small rural CHSLDs remain limited. OBJECTIVE This study aimed to assess the added value of overnight nursing teleconsultation in small rural long-term care centers (≤50 beds) by analyzing its clinical, organizational, and economic impact using a value-based healthcare (VBHC) approach. METHODS A 6-month pilot project was conducted sequentially in three rural CHSLDs located in two administrative regions of Quebec between July 2022 and March 2023. Researchers adopted a mixed methods approach. Qualitative data were collected through 38 semistructured interviews with nursing staff (n=9, 24%), managers (n=27, 71%), and resident committee presidents (n=2, 5%). Quantitative data focused on teleconsultation calls, costs, and associated cost savings. RESULTS The pilot project helped improve access to nursing expertise during night shifts, strengthen clinical decision-making, and increase residents’ and staff’s sense of safety. Over 231 nights of remote on-call nursing, 21 teleconsultation calls were logged, relating mainly to falls, pain, and clinical deterioration. The majority of teleconsultations (86%) were conducted without the use of Teams videoconferencing, mainly because it was simpler or faster to carry out the intervention. No hospital transfers were required during the nights covered by the project. The qualitative data highlight strengthened clinical leadership, greater autonomy and professional confidence among nursing assistants, improved clinical collaboration, and reduced professional isolation. Financially, non-recurring costs associated with implementation were offset by estimated savings of between $49,000 and $64,000 per CHSLD over six months, mainly due to reduced on-call hours and the elimination of unnecessary travel. CONCLUSIONS Overnight nursing teleconsultation is an efficient, human-centered solution to support the quality, continuity, and safety of care in small rural CHSLDs. By simultaneously improving clinical outcomes, supporting professionals, and optimizing resources, this model is fully aligned with VBHC principles and represents a promising avenue to strengthen long-term care in resource-limited settings.