Evaluating Clinical and Educational Experiences with Telemedicine in a Multidisciplinary High-Risk Infant Follow-Up Program due to the COVID-19 Response

Abstract

Program Goals: Prior to COVID-19, infants at increased risk of poor growth, feeding difficulties, andneurodevelopmental disabilities due to prematurity or other congenital diagnoses were evaluated in-personduring the course of one patient encounter by our multidisciplinary team, consisting of two general pediatricproviders (MD and PNP), one PGY-3 resident physician, and an MA, RN, RD, LCSW, and SLP The pandemicresponse created the need for our team to rapidly convert evaluations to a telemedicine platform whilemaintaining a robust resident educational experience Program goals for transitioning to a telemedicineplatform were 1) to maintain access to a multidisciplinary evaluation for patients and families and 2)continued involvement of residents in patient encounters Three telemedicine platforms supported by ourinstitution were trialed to assess which one best-supported multi-participant use The clinical flow model usedby the program during in-person visits was also adapted for the telemedicine platform This included a virtual pre-clinic huddle with the multidisciplinary team, followed by the RN Program Coordinator introducing teammembers and outlining the sequence of the virtual visit for each patient and family in real-time Evaluation:The multidisciplinary team was offered a voluntary anonymous online survey about their experience withtelemedicine 88 % of respondents (n=9) had no previous telemedicine experience Respondents had higherrates of satisfaction for return visits compared to new visits (Figure 1) Disadvantages of virtual visits includedlimited physical assessment of patients (including accurate measurements) and decreased communicationbetween residents and staff outside of the pre-clinic huddle Advantages of virtual visits included improvedaccess for families and added insight about social determinants of health observed in the home setting 100%of resident respondents to date (n=3) rated their overall telemedicine educational experience as average toabove average and rated the quality of feedback as unchanged between virtual and in-person visits Comparison of encounter data between April 2019 and April 2020 showed similar fill rates and no-show rates(Table 1) At the time of presentation, we anticipate comparing encounter data from April through August in2019 and 2020 and having data from an additional 20-24 residents Discussion: Since transitioning to atelemedicine platform in response to COVID-19, our high-risk infant follow-up program has maintained patientaccess to a multidisciplinary evaluation and continued to involve residents in virtual patient encounters Planned adaptations include streamlining the use of technology to preserve resident autonomy in decision-making The program will continue to advocate with state Medicaid to expand provision of home infant scalesto improve patient assessment Ongoing analysis of patient/family satisfaction along with studying theadvantages and disadvantages of the telemedicine platform between multidisciplinary members andresidents will allow for development of best practices for the use of telemedicine in an educational setting