266 Background: During the COVID-19 pandemic, the need for telehealth has come to the forefront of healthcare. In the right clinical context, telehealth is an easy and effective way for providers to deliver high quality care, while also taking away barriers to care access such as clinic inconvenience, distance traveled, financial toxicity, etc. An abundance of data exists regarding the benefits and potential of telehealth, but most data is from the perspective of the provider. Unfortunately, there is little information regarding the patient’s perspective and satisfaction; and even less regarding accessibility issues in terms of technology and cultural perception of telehealth. We postulate that there is a need for individualized grass root level understanding of the population being served to make sure telehealth adoption is sustained and equitable. We are studying this using a rapid cycle improvement project using a Plan Do Study Act format (PDSA), with a cohort of veterans in a medical oncology clinic in Birmingham, AL. Methods: We spoke with a pilot cohort of 67 patients in the medical oncology clinic at the VA Medical Center in Birmingham, AL. Surveys were done on all patients prior to their initial telehealth visit. Patients first agreed to participate, and then answered a 6-question survey regarding their perception of telehealth, their willingness to participate, and their perceived barriers to participation. We then identified barriers to intervene upon, with the plan to engage senior VA Leadership for the same. Results: 67 medical oncology patients in the Birmingham VA between May 1 and May 31, 2020, agreed to participate in a survey prior to their first telehealth appointment. We found that of the 67 patients surveyed, only 48 (71.6%) had a video capable phone and only 41 (61.2%) had high-speed internet or data to support that call. Interestingly 25 patients (37%) did not feel they could access the video on their own phone. While this presented one barrier to telehealth, we also found that 11 patients (16.4%) would not want to participate in telehealth even if they had a video capable device. Conclusions: This data, while not exhaustive, clearly captures some unique barriers to telehealth that may not have been previously studied or understood. Hearing the voice of the patient is critical in developing culturally competent forms of telehealth delivery. We will use this data to implement interventions that not only provide access of technology for our patients but will also make sure to specifically address the cultural/socioeconomic barriers to this form of healthcare distribution and how to overcome those barriers.

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PURPOSE: COVID-19 challenged medical practice and graduate medical education. Building on previous initiatives, we describe and reflect on the formative process and goals of the Hematology-Oncology Collaborative Videoconferencing Learning Initiative, a trainee-led multi-institutional virtual COVID-19 learning model. METHODS: Clinical fellows and faculty from 13 US training institutions developed consensus needs, goals, and objectives, recruited presenters, and generated a multidisciplinary COVID-19 curriculum. Weekly Zoom conferences consisted of two trainee-led instructional segments and a trainee-moderated faculty Q&A panel. Hematology-oncology training program faculty and trainees were the targeted audience. Leadership evaluations consisted of anonymized baseline and concluding mixed methods surveys. Presenter evaluations consisted of session debriefs and two structured focus groups. Conference evaluations consisted of attendance, demographics, and pre- or postmultiple-choice questions on topic learning objectives. RESULTS: In 6 weeks, the initiative produced five conferences: antivirals, anticoagulation, pulmonology, provider resilience, and resource scarcity ethics. The average attendance was 100 (range 57-185). Among attendees providing both pre- and postconference data, group-level knowledge appeared to increase: antiviral (n = 46) pre-/postcorrect 82.6%/97.8% and incorrect 10.9%/2.2%, anticoagulation (n = 60) pre-/postcorrect 75%/93.3% and incorrect 15%/6.7%, and pulmonary (n = 21) pre-/postcorrect 66.7%/95.2% and incorrect 33.3%/4.8%. Although pulmonary management comfort appeared to increase, comfort managing of antivirals and anticoagulation was unchanged. At the conclusion of the pilot, leadership trainees reported improved self-confidence organizing multi-institutional collaborations, median (interquartile range) 58.5 (50-64) compared with baseline 34 (26-39), but did not report improved confidence in other educational or leadership skills. CONCLUSION: During crisis, trainees built a multi-institutional virtual education platform for the purposes of sharing pandemic experiences and knowledge. Accomplishment of initiative goals was mixed. Lessons learned from the process and goals may improve future disaster educational initiatives.

Introduction: Guidelines from the American Society of Hematology recommend consideration of outpatient management, rather than hospitalization, for patients with pulmonary thromboembolism (PTE) with low risk of complication. The simplified Pulmonary Embolism Severity Index (sPESI) is frequently used for PTE risk stratification and selection for outpatient management, where an sPESI of 0 is associated with a low risk of recurrent thromboembolism, non-fatal bleeding, and death. Prior to developing an outpatient care pathway for low risk PTE at a large, public academic medical center, we sought to assess the potential clinic volume by determining the number of patients seen at our institution with low risk acute PTE. We also sought to capture other features that may preclude outpatient management including renal impairment, thrombocytopenia, and obesity, which may prevent direct oral anticoagulant (DOAC) use, and lack of insurance, which may impede access to affordable anticoagulation and clinic follow-up. Methods: We retrospectively identified patients with acute PTE by reviewing computed tomography (CT) of the chest with contrast or CT angiography performed during a one-year period (Oct 1, 2018 to Sept 30, 2019) using CPT codes. Imaging reports were manually reviewed to determine if acute PTE was present. sPESI variables were collected: age >80, history of cancer, history of cardiopulmonary disease, heart rate (HR) ≥110bpm, systolic blood pressure (SBP) <100mmHg, and oxygen saturation (O 2) <90%. Medical history variables were identified using ICD-10 codes. Vital sign values were determined by identifying peak or nadir as appropriate within 24 hours of encounter initiation. Additional demographic and clinical variables collected included sex, weight, body mass index (BMI), insurance status, serum creatinine, platelet count, and length of stay for admitted patients. Readmission was determined by reviewing documentation within 30 days of initial encounter. Values were reported using frequencies with percentages and means with standard deviation and/or range. Comparisons were performed using chi squared tests and t tests as appropriate. Results: Of 587 CT chest imaging studies identified, 199 (34%) demonstrated acute PTE (Figure 1). The majority (n=174, 87%) had an sPESI of 1 or greater. Points were more frequently gained due to SBP <100mmHg (n=109, 63%), HR ≥110bpm (n=105, 60%), and O 2 ≤90% (n=90, 52%). History of cancer was present in 54 patients (31%) and history of cardiopulmonary disease in 81 patients (47%), with a total of 113 patients (65%) having a history of either. Only 25 patients (13%) had a low risk sPESI score of 0. Two patients with sPESI of 0 were excluded from further analysis due to age <18 and transfer to an outside hospital. Table 1 includes a comparison of the demographic and clinical features of all patients with acute PTE versus those with sPESI of 0. Of those patients with a low risk sPESI, 3 patients (13%) had another indication for hospital admission aside from acute PTE (Figure 1). Three patients (13%) had a BMI greater than 40kg/m 2 and a weight greater than 120 kilograms. No patients had significant renal impairment, with a serum creatinine ranging between 0.5-1.5mg/dL. No patients had significant thrombocytopenia. Three patients (13%) were uninsured, 1 of whom was admitted for another indication. The majority of patients with sPESI of 0 were admitted (n=19, 83%) with an average length of stay of 1.8 days (SD 1.6, range 0.2-7.4). Two patients were discharged from the emergency department (ED), and 2 patients were diagnosed and managed by an outpatient provider without contact with the ED or hospital. Only 1 patient was readmitted to the hospital within 30 days for reasons unrelated to PTE. Conclusions: Our results indicate that the annual volume for a low risk PTE outpatient management pathway at a large, public medical center would be low, with only 20 patients meeting eligibility per sPESI in 12 months. Patients were frequently disqualified for vital sign abnormalities, but over half were ineligible due to comorbidities. This quantification will allow our institution and others that are similar to gauge the potential resource allotment needed for low risk pathway development. In addition, we demonstrate that 10% of eligible patients were uninsured, emphasizing that access to affordable anticoagulation and follow-up is necessary when developing outpatient PTE care models. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.