Adapting Interstage Home Monitoring with the use of Telemedicine During the COVID-19 Pandemic

Abstract

Pediatric single ventricle patients have seen dramatic improvements in overall outcomes over the past several decades. This is attributed to the development of home monitoring programs for interstage patients. In today’s current COVID-19 pandemic, the use of telemedicine has allowed providers to care for these patients and support their families effectively while minimizing the risk of COVID-19 exposure. Our single-center study reviewed the charts of nine patients followed by our single ventricle team through the COVID-19 pandemic. Patients discharged from the hospital and enrolled in our digital home monitoring program were included. Records were retrospectively reviewed for total number of outpatient visits, adverse events, unplanned hospital readmissions, and unplanned procedures. These results were then compared to outcomes from 2018 to 2019. In-person visits averaged every 6 weeks compared to every 2–3-week pre-pandemic. Zero adverse events reported with the use of telemedicine compared to one adverse event pre-pandemic. There was a 50% decrease in unplanned readmissions and 60% decrease in unplanned procedures during our study period. One patient was diagnosed with acute COVID-19 infection and managed conservatively via telemedicine with full recovery. To our knowledge, this is the only case–control study reporting the use of telemedicine during the COVID-19 pandemic in the interstage population. Although not statistically significant, we report a decrease in total adverse events, unplanned procedures, and unplanned admissions. Telemedicine visits allowed for identification of issues requiring hospital readmission as well as conservative management of one patient with COVID-19.

Telemedicine in pediatric cardiology: pros and cons

“…Studies support the feasibility of asynchronous telemedicine in these patients [10–13]. Few studies have reported on the use of synchronous telemedicine for home monitoring in this high-risk population [11,13,14]. In a large study involving 60 visits [14], telemedicine proved to be an efficient care model, allowing for rapid identification of potentially serious issues and prompting expedited care.…”

“…In-home monitoring programs, in addition to frequent, in-person evaluations, have been successful in decreasing interstage mortality [8,9]. Studies support the feasibility of asynchronous telemedicine in these patients [10][11][12][13]. Few studies have reported on the use of synchronous telemedicine for home monitoring in this high-risk population [11,13,14].…”

“…Caregivers and clinicians expressed high levels of satisfaction with telemedicine [11,14]. During the COVID-19 pandemic, telecardiology was particularly effective in adapting care [13,14].…”

Impact of Technologic Innovation and COVID-19 Pandemic on Pediatric Cardiology Telehealth

“…The opportunity for virtual multidisciplinary meetings with the patient and caregiver promotes patient-centered care models. Overall, DTC visits have proven highly effective in this regard as seen by high patient satisfaction rates and no reports of resultant adverse outcomes [ 10 •, 11 ••, 12 ]. While the aim of DTC visits is to improve efficiency, it must not compromise quality of care.…”

Feasibility of Digital Stethoscopes in Telecardiology Visits for Interstage Monitoring in Infants with Palliated Congenital Heart Disease

“…It has been reported that up to 18% of infants with single ventricle physiology die unexpectedly after being discharged to home [ 1 ], although home-monitoring programs have lowered interstage mortality in infants with HLHS and related variants [ 2 , 3 ]. Telehealth has been used in this population in an asynchronous manner [ 4 – 7 ] and more recently, feasibility of synchronous telecardiology visits (TCV) has been demonstrated [ 6 , 7 ], including the experience of our center. [ 8 ] Since 2010, the Children’s Hospital of Philadelphia (CHOP) home-monitoring program, The Infant Single Ventricle Monitoring & Management Program (ISVMP), has cared for over 800 infants requiring staged surgical palliation for congenital heart disease, with a low incidence of morbidity and mortality [ 9 ].…”