Rapid Implementation of a Direct-to-Consumer Pediatric Virtual Urgent Care in Response to the COVID-19 Pandemic

Abstract

Background: Many visits to pediatric emergency departments are sub-acute in severity and could be amenableto a direct-to-consumer telemedicine encounter The SARS-CoV-2 outbreak has created a unique need fortelemedicine as far fewer patients have sought ambulatory in-person care across our entire system Presumably, many of these patients have problems amenable to telemedicine but are choosing to delayseeking care Objective: We sought to rapidly develop a direct-to-consumer pediatric virtual urgent careservice to enhance access to care for patients and parents during the SARS-CoV-2 pandemic Methods: Todevelop our program we enlisted key stakeholders from the division of pediatric emergency medicine, thehospital executive leadership, the hospital telemedicine program, our affiliated health plan administration andan existing virtual urgent care administered by our affiliated division of emergency medicine We adoptedAmerican Well as our telemedicine platform, utilizing their native urgent care software Families access thisservice either through a smart device app or a secure website Providers see patients either in a repurposed ED office with telemedicine equipment or from home using a variety of technology solutions We staff ourservice 24/7 with our existing group of pediatric emergency medicine physician assistants and nursepractitioners Providers and patients were surveyed regarding their experience with the service Visit data were summarized and analyzed in a Power BI dashboard and in Microsoft Excel Results: We implemented ourprogram on March 30, 2020 after two weeks of development and training, 19 days after the rst case ofCOVID-19 in our county In our rst 30 days of operation 580 unique visits were completed, 25% of which werefrom outside our typical ED catchment area Mean visit duration was 7 minutes and mean wait time was 8minutes Mean hourly volumes showed a peak from 10AM to 8PM (see Figure 1) Patients and families (247responses) were satised with the care they received and the quality of the technology, on average rating both4 9 on a 5 point scale The most common chief complaints were rash, cold, fever, sore throat and ear pain (seeFigure 2) Eighty percent of patients were subscribers of our affiliated health plan Additional data analysisincludes frequency of technical problems, frequencies of the most common diagnoses, frequency of referralfor an in-person evaluation, frequency of prescription of any type and for antibiotics (and comparison tonational trends), payor details, and frequency of outpatient SARS-CoV-2 testing Detailed provider and patientsurveys are pending Conclusions: A direct-to-consumer pediatric telemedicine service can be rapidlydeveloped and deployed to respond to a sudden change in needs of a population This type of service isconvenient for families that want to seek care from home and broadly acceptable to patients and providers Volume and Visit Metrics Visits are summed and represented as a histogram by hour Visit duration (dashed line) and wait time (solidline) are averaged for each hour and represented in aggregate Visit Reason Word Cloud Larger size indicates a more frequent visit reason The most common visit reasons were rash, cold, fever, sorethroat and ear pain