Introduction: The novel coronavirus disease 2019 (COVID-19) created challenges with access to care including increased burden on healthcare systems and potential exposure risks for vulnerable patients. To address these needs, Rush University Medical Center created a virtual, urgent care program specifically designed to address these challenges during the COVID-19 pandemic. Methods: This was a retrospective study analyzing adult patients with COVID-19-related telemedicine visits performed between March 1–June 30, 2020. COVID-19-related telemedicine visits refer to those who used the “Concern for Coronavirus” module. We assessed the total number of telemedicine visits using this module, percentage with a subsequent emergency department (ED) visit within seven days, and outcomes (ie, hospitalization status, intubation, and death) of patients who presented to the ED for evaluation. Data are presented using descriptive statistics. Results: A total of 2,974 adult patients accessed the program via the COVID-19 module over the four-month period. Of those, 142 patients (4.8%) had an ED visit within seven days. Only 14 patients (0.5%) required admission. One patient was intubated, and there were no deaths among the telemedicine population. Conclusion: The data suggests that telemedicine may be a safe and effective way to screen and treat patients with possible COVID-19, while reducing potential burdens on EDs.

No abstract

A 66-year-old man with symptomatic hypertensive episodes was found to have a 9-mm adrenal mass and elevated metanephrine levels. He was scheduled for an adrenalectomy for suspected pheochromocytoma. Subsequent workup revealed a large bladder mass which was found to be a paraganglioma. There is no consensus on what should be considered the standard management of primary bladder paraganglioma, including surgical technique, assessment of malignancy, and appropriate follow-up, owing to the rarity of the diagnosis.

No abstract

Palliative care consultation in the emergency department (ED) can be helpful to ED teams, patients, and families alike. The emergency clinician may, through a more objective approach, be able to identify unmet palliative care needs, such as functional debility, symptom burden, and lack of prognostic awareness. Earlier palliative care involvement has been shown to significantly decrease hospital length of stay and cost, and it has demonstrated marked improvements in depression, anxiety, and well-being across multiple disease states. Subspecialty palliative care consultation in the ED can be helpful in several ways. First, it can assist with gaining a broader view of the clinical course and gather additional history and perspective that might not have been gained through coordination with other providers or additional historians. Consultants can help clarify a patient’s goals of care, assist with difficult symptom management, and help provide guidance on patients enrolled in hospice or with hospice enrollment from the ED. Palliative care consultants can also assist in disposition determination and help to create safe discharge and follow-up plans. There is a spectrum of models for how palliative care can support the ED, ranging from “as needed” palliative consultation by standard ED practice, to dedicating and embedding a multidisciplinary palliative care team into the ED.