基于COVID-19应对的多学科高危婴儿随访项目中远程医疗的临床和教育经验评估

Katie Swec, A. Hines, D. Szczepaniak, Emily Scott
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摘要

项目目标:在COVID-19之前,我们的多学科团队在一名患者就诊过程中亲自评估了因早产或其他先天性诊断导致生长不良、喂养困难和神经发育障碍风险增加的婴儿,该团队由两名普通儿科医生(MD和PNP)、一名PGY-3住院医师、一名MA、RN、RD、LCSW、流行病的应对使我们的团队需要快速将评估转换为远程医疗平台,同时保持强大的住院医生教育体验。向远程医疗平台过渡的项目目标是:1)为患者和家属提供多学科评估;2)住院医生继续参与患者就诊。我们对我们机构支持的三个远程医疗平台进行了试验,以评估哪一个平台最受支持该项目在亲自就诊期间使用的临床流程模型也适用于远程医疗平台,其中包括与多学科团队的虚拟临床前会议。随后由注册护士项目协调员介绍团队成员,并为每位患者和家属概述实时评估的虚拟就诊顺序:多学科团队接受了一项关于远程医疗体验的自愿匿名在线调查,88%的受访者(n=9)以前没有远程医疗经验,受访者对回访的满意度高于新访(图1)虚拟就诊的优势包括改善了家庭的访问机会,并增加了对家庭环境中健康的社会决定因素的见解。到目前为止,100%的居民受访者(n=3)将他们的整体远程医疗教育经历评为平均或高于平均水平,并将虚拟和面对面的反馈质量评为不变2019年4月和2020年4月的就诊数据比较显示出相似的填充率和缺席率(表1)在报告时,我们预计将比较2019年4月至8月和2020年的就诊数据,并从另外20-24名居民那里获得数据。自为应对COVID-19而过渡到远程医疗平台以来,我们的高危婴儿随访项目为患者提供了多学科评估的机会,并继续让住院医生参与到虚拟患者接触中。计划中的调整包括简化技术的使用,以保持住院医生在决策中的自主权。该项目将继续与国家医疗补助计划合作,扩大家庭婴儿规模的提供,以提高患者评估多学科成员和住院医生之间远程医疗平台的缺点将允许在教育环境中开发使用远程医疗的最佳实践
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Evaluating Clinical and Educational Experiences with Telemedicine in a Multidisciplinary High-Risk Infant Follow-Up Program due to the COVID-19 Response
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
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