Telehealth is an important tool utilized to provide remote clinical care and has increased in prevalence during the coronavirus disease of 2019 (COVID-19) pandemic. It allows providers to conduct safe, timely, and high-quality ambulatory care for patients without increasing risk of disease exposure for both parties. Major organizations including the Centers for Disease Control and Prevention and American College of Obstetrics and Gynecology have released recommendations encouraging the use of telehealth systems for patient care. In obstetrics and gynecology, practice of telehealth has not been commonplace and no practical procedural guidelines have been published. The authors have created such guidelines for use of telehealth in a moderate-risk academic generalist practice in response to the COVID-19 pandemic. This document highlights the process to determine which obstetrics and gynecology patients are candidates for telehealth, the frequency of follow-up, and the technical aspects of designing and delivering a de novo telehealth system. The guidelines were vital in providing structure amid a sudden transition in an academic setting while ensuring patient and provider safety.

INTRODUCTION:Sex disparities in a perioperative emergency warrant investigation to improve equitable patient care. We investigated whether differences exist in care of appendicitis across patient sex.METHODS:We performed a retrospective cohort study of patients with appendicitis between 2011 and 2020 at an inner-city academic hospital. We collected demographic data and time records of key milestones in clinic care. We used chi-square, paired t test, ANOVA, and Cox proportional hazard analyses to examine differences between sex and other factors.RESULTS:A total of 385 patients were included, 182 (47.3%) females and 203 (52.7%) males. Patients were similar across sex, age, race, reason for visit, and number of emergency room visits. The time to admission for females was longer as compared to males (t(304)=–2.82, P<.05). Cox proportional hazard analysis predicting time to admission based on sex while controlling for age and race showed that females have a longer time to admission (HR 0.73 [95% CI 0.58–0.92]), youngest patients (<15 years) were admitted faster than older-aged patients (HR 2.13 [95% CI 1.45–3.13]), and as compared with Black patients, White patients were admitted faster (HR 1.56 [95% CI 1.06–2.29]).CONCLUSION:Reproductive-aged females had significantly longer times to admission than male peers with the same indication, and White patients were admitted more expeditiously than Black patients. There was a trend of slower surgical consult and admission for females with gynecological disorders. This study suggests that sex biases exist within our system. This highlights that an active effort must be taken to rule out differentials that are not sex based.

No abstract