Quality and Safety Analysis of 2,999 Telemedicine Encounters During the COVID-19 Pandemic

Abstract

Abstract:Objective:To examine if telemedicine remains safe and of high quality despite rapid expansion of services by comparing telemedicine encounters prior to and during COVID 19 pandemic.Methods:Pre-post study investigating 2999 telemedicine encounters: 2/1/2020 - 5/15/2020. 2919 completed visits before and after strict social distancing implementation were analyzed for patient and provider characteristics, encounter characteristics (history, physical exam, etc) and quality and safety metrics (phone calls <=7 days post visit, visit- cause specific hospital admission or mortality <=30 days after visit). Stratified analysis of 3 groups for outcomes (young age, neuromuscular diagnosis and new encounters) was performed.Results:Patients ranging from 1 month old to 33 years were seen. Rural patients were less likely to be seen during pandemic compared to urban patients(8 % vs 90% p< 0.0001); teaching clinic and specialty clinic encounters increased significantly during pandemic ( 8% vs 3% ; p=0.005), documentation of at least two systems on exam was noted significantly more frequently during pandemic ( 13% vs 7%; p=0.009). No deaths were reported. There were no differences pre/ during pandemic for safety or telemedicine failure metrics within entire group and high-risk subgroupsConclusions:Despite a markedly and rapidly expanded scope of ambulatory telemedicine care during the COVID19 pandemic, telemedicine remained a safe and high-quality option for pediatric neurology patients. Additionally, populations perceived as high risk for telemedicine (the very young, new patients and those with neuromuscular diagnoses) can benefit from telemedicine visits, particularly when access to in-person care is limited.

Telemedicine in Pediatric Headache: A Review and Practical Implementation

“…Pediatric neurologists are not exempt from this, especially those managing pediatric headache. Unfortunately, to date, only a few studies have examined the use of telemedicine in pediatric headache; however, all have shown excellent promise [ 4 ••, 8 •, 26 , 33 •, 34 •].…”

“…Within 8–30 days of the visit, 0.8 percent of patients were admitted and no deaths were seen throughout the entire study. While this study analyzed all pediatric neurology patients seen via telemedicine, at least 594 of them were diagnosed with headache or migraines [ 34 •]. This study also found that there was no difference in the rate of subsequently performed in-person examinations nor hospitalizations when comparing new and established telemedicine patients [ 34 •].…”

“…Both groups had equivalent headache outcomes, neurodiagnostic findings, and rates of secondary headaches [ 29 ]. The evaluation of new patients via telemedicine is often viewed with anxiety due to the difficulty performing a comprehensive neurologic examination and ruling out secondary processes [ 10 , 26 , 33 •]; however, both of these studies suggest that telemedicine is safe and adequate for this process [ 29 , 34 •]. Additionally, it is felt that careful screening for red flag symptoms and referral to local specialists when indicated are sufficient to overcome this barrier [ 6 , 9 •, 30 , 33 •].…”

“…When this is not feasible, planned in-person follow-up is a reasonable alternative [ 6 ]. Outside of the concerns surrounding remote examinations, many providers have concerns about the technologic side of telemedicine [ 1 , 4 ••, 8 •, 34 •]. This seems unfounded as rates of audio-visual malfunctions were rare [ 8 •, 34 •].…”

“…Outside of the concerns surrounding remote examinations, many providers have concerns about the technologic side of telemedicine [ 1 , 4 ••, 8 •, 34 •]. This seems unfounded as rates of audio-visual malfunctions were rare [ 8 •, 34 •]. In fact, out of over 2000 pediatric neurology telemedicine appointments, only 1 percent experienced a technical challenge necessitating transition to a telephone call [ 34 •].…”