A multidisciplinary telemedicine model for management of coronavirus disease 2019 (COVID-19) in obstetrical patients

Abstract

BACKGROUND: The COVID-19 pandemic caused by the SARS-CoV-2 has increased the demand for inpatient healthcare resources; however, approximately 80% of patients with COVID-19 have a mild clinical presentation and can be managed at home. OBJECTIVE: This study aimed to describe the feasibility and clinical and process outcomes associated with a multidisciplinary telemedicine surveillance model to triage and manage obstetrical patients with known exposures and symptoms of COVID-19. STUDY DESIGN: We implemented a multidisciplinary telemedicine surveillance model with obstetrical physicians and nurses to standardize ambulatory care for obstetrical patients with confirmed or suspected COVID-19 based on the symptoms or exposures at an urban academic tertiary care center with multiple hospital-affiliated and community-based practices. All pregnant or postpartum patients with COVID-19 symptoms, exposures, or hospitalization were eligible for inclusion in the program. Patients were assessed by means of regular nursing phone calls and were managed according to illness severity. Patient characteristics and clinical and process outcomes were abstracted from the electronic medical record. RESULTS: A total of 135 patients were enrolled in the multidisciplinary telemedicine model from March 17 to April 19, 2020, of whom 130 were pregnant and 5 were recently postpartum. In this study, 116 of 135 patients (86%) were managed solely in the outpatient setting and did not require an in-person evaluation; 9 patients were ultimately admitted after ambulatory or urgent evaluations, and 10 patients were observed after hospital discharge. Although only 50% of the patients were tested secondary to limitations in ambulatory testing, 1 in 3 of those patients received positive results for SARS-CoV-2 (N¼22, 16% of entire cohort). Patients were enrolled in the telemedicine model for a median of 7 days (interquartile range, 4e8) and averaged 1 phone call daily, resulting in 891 nursing calls and 20 physician calls over 1 month. CONCLUSION: A multidisciplinary telemedicine surveillance model for outpatient management of obstetrical patients with COVID-19 symptoms and exposures is feasible and resulted in rates of ambulatory management similar to those seen in nonpregnant patients. A centralized model for telemedicine surveillance of obstetrical patients with COVID-19 symptoms may preserve inpatient resources and prevent avoidable staff and patient exposures, particularly in centers with multiple ambulatory practice settings.

Impacto da pandemia de SARS-CoV-2 na saúde mental de gestantes e puérperas: uma revisão integrativa

“…Essas dificuldades transpassam tempos de pandemias, porém tornaram-se mais evidentes. Entre as potencialidades da telemedicina, encontram-se a possibilidade de maior da adesão da população com acesso à Internet e dispositivos às atividades relacionadas tanto ao pré-natal quanto ao acompanhamento no puerpério devido à maior facilidade e agilidade no acesso às informações (Reforma et al 2020).…”

Effects of the Covid-19 Pandemic on Maternity Staff in 2020 – A Scoping Review

“…Though only 45% of them had taken advantage of existing telehealth technologies before the pandemic, 89% wanted to continue to use the technology after the pandemic [45]. Virtual meetings also enabled maternity staff to care for women who would not have otherwise had contact with a midwife because of barrier like travel time or other time limitations, health restrictions, or lack of available childcare [40,41,44,46]. In Germany, there have been reports that laws are changing medical billing options for digital care; midwives could not bill for this before the pandemic [17,28].…”

Patient Satisfaction with Virtual-Based Prenatal Care: Implications after the COVID-19 Pandemic

“…To limit prenatal COVID-19 exposure, the American College of Obstetricians and Gynecologists and the Center for Disease Control and Prevention suggested including some virtual visits in place of routine prenatal care (Lowery et al, 2020 ; National Center for Health Statistics, 2020 ). Indeed, prenatal care models with telehealth appointments have been implemented (Aziz et al, 2020 ; Fryer et al, 2020 ; Peahl et al, 2020a ; Reforma et al, 2020 ; Zork et al, 2020 ). However, given the rapid shift from in-person care to virtual visits, very little is known regarding patient satisfaction of virtual prenatal care during the pandemic.…”