Pediatric Otolaryngology Telehealth in Response to COVID-19 Pandemic: Lessons Learned and Impact on the Future Management of Pediatric Patients

Abstract

Background: Since the start of the COVID-19 pandemic outpatient medicine has drastically been altered how it is delivered. This time period likely represents the largest volume of telehealth visits in the United States health care history. Telehealth presents unique challenges within each subspecialty, and pediatric otolaryngology is no different. This retrospective review was designed to evaluate our division of pediatric otolaryngology’s experience with telehealth during the COVID19 pandemic. Methods: This study was approved by the Institutional Review Board at Vanderbilt University Medical Center. All telehealth and face-to-face visits for the month of April 2020 completed by the Pediatric Otolaryngology Division were reviewed. A survey, utilizing both open-ended questions and Likert scaled questions was distributed to the 16 pediatric otolaryngology providers in our group to reflect their experience with telehealth during the 1-month study period. Results: In April, 2020 our outpatient clinic performed a total of 877 clinic visits compared to 2260 clinic visits in April 2019. A total of 769 (88%) were telehealth visits. Telemedicine with video comprised 523 (68%) and telephone only comprised 246 (32%). There were 0 telehealth visits in April 2019. Interpretive services were required in 9.3% (N = 211) clinic visits in April 2019 and 7.5% (N = 66) of clinic visits in April 2020. The survey demonstrated a significant difference ( P < .00002) in provider’s anticipated telehealth experience (mean 3.94, 95% CI [3.0632, 4.8118] compared to their actual experience after the study period (mean 7.5, 95% CI [7.113, 7.887]. Conclusions: Despite low initial expectations for telehealth, the majority of our providers felt after 1 month of use that telehealth would continue to be a valuable platform post-pandemic clinical practice. Limited physical exam, particularly otoscopy, nasal endoscopy, and nasolaryngoscopy present challenges. However, with adequate information and preparation for the parents and for the physician some of the obstacles can be overcome.

Pediatric Telemedicine

“… 22 Training caregivers to conduct physical exams may improve the quality of exams; tools such as dolls, cards, and checklists could help to facilitate effective and efficient virtual visits. 25 , 29 , 31 …”

“… 40 Additionally, while patient-generated measurements have the potential to increase the provider confidence and support a shift to alternating or supplementing in-person and telemedicine visits, parents may have low self-efficacy with regard to home measurements. 23 , 31 Thus, appropriate training of caregivers and better evidence are necessary to ensure successful use of home monitoring devices and a positive caregiver experience.…”

Telemedicine and Telementoring in Rhinology, Otology, and Laryngology: A Scoping Review

“…During COVID-19, there has been a surge in literature describing the implementation and efficacy of the tele-clinic, 155-168 especially when compared with a similar period prior to the pandemic. 157,162 Some studies reported no-shows to be more frequent when the tele-visit was utilized, 158 while others noted attendance to increase.…”

“…86 At an institution level, the cost reduction was achieved after the number of tele-visits surpassed the threshold to pay off the fixed costs from the initial technology installment; for example, in 1 study this was reported at a threshold of 35 patients per year. 11,152,153 During COVID-19, there has been a surge in literature describing the implementation and efficacy of the teleclinic, [155][156][157][158][159][160][161][162][163][164][165][166][167][168] especially when compared with a similar period prior to the pandemic. 157,162 Some studies reported no-shows to be more frequent when the tele-visit was utilized, 158 while others noted attendance to increase.…”

“…11,152,153 During COVID-19, there has been a surge in literature describing the implementation and efficacy of the teleclinic, [155][156][157][158][159][160][161][162][163][164][165][166][167][168] especially when compared with a similar period prior to the pandemic. 157,162 Some studies reported no-shows to be more frequent when the tele-visit was utilized, 158 while others noted attendance to increase. 160,168 Some reported reasons for no-shows included technical issues 158,159 or patients declining it due to no direct physical examination.…”