: Background Telemedicine is uniquely positioned to address challenges posed to emergency departments (EDs) by the COVID-19 pandemic. By reducing in-person contact, it should decrease provider risk of infection and preserve personal protective equipment (PPE). Objectives To describe and assess the early results of a novel telehealth workflow in which remote providers collaborate with in-person nursing to evaluate and discharge well-appearing, low-risk ED patients with suspected COVID-19 infection. Methods Retrospective chart review was completed three weeks after implementation. Metrics include the number of patients evaluated, number of patients discharged without in-person contact, telehealth wait time and duration, collection of testing, ED length of stay (ED-LOS), 72-hour return, number of in-person healthcare provider contacts, and associated PPE use. Results Among 302 patients evaluated by telehealth, 153 patients were evaluated and discharged by a telehealth provider with reductions in ED-LOS, PPE use, and close contact with healthcare personnel. These patients had a 62.5% shorter ED-LOS compared to other ESI Level 4 patients seen over the same time period. Telehealth use for these 153 patients saved 413 sets of PPE. We observed a 3.9% 72-hour revisit rate. One patient discharged after telehealth evaluation was hospitalized on a return visit 9 days later. Conclusion Telehealth can be safely and efficiently used to evaluate, treat, test, and discharge ED patients suspected to have COVID-19. This workflow reduces infection risks to healthcare providers, PPE use, and ED-LOS. Additionally, it allows quarantined but otherwise well clinicians to continue working.

Neisseria, of the family Neisseriacea, are gram-negative, nonmotile, and non–spore-forming bacteria. The pathogens Neisseria gonorrhoeae and Neisseria meningitidis have been extensively studied and have long been recognized as human-specific pathogenic bacteria. Other members of the Neisseria genus, are nonpathogenic and are normal inhabitants of the upper respiratory tract. However, recent reports suggest that these normally nonpathogenic bacteria have the potential to produce infection. Cases of Neisseria species causing bacteremia, endocarditis, and pneumonia have been documented, as well as infection in immune-compromised hosts. Currently, there is a paucity of data regarding Neisseria species infection in patients with cancer. We report a case series of nongonococcal and nonmeningococcal Neisseria infection in patients with underlying malignancy to add to this limited body of knowledge and to provide further evidence of the opportunistic potential of these species in immune-compromised hosts.