Inpatient Telehealth and Coronavirus Disease 2019 Outcomes: Experiences in Alabama

Abstract

Background: During the early months of the coronavirus disease 2019 (COVID-19) pandemic, hospitals were concerned about preserving personal protective equipment. UAB Hospital Medicine designed a strategy to outfit acute care patient rooms on a COVID-19 unit with telemedicine technology to allow for remote clinician rounding.Objective: To describe one hospital's experience with inpatient telehealth and compare outcomes between patients with and without inpatient telehealth visits. Design and Methods: Retrospective chart review of patients admitted to UAB Hospital Medicine with COVID-19 between March 16, 2020 and April 24, 2020. Logistic and negative binomial regression models were used to examine the relationship between telehealth visits and the likelihood of a subsequent transfer to the intensive care unit (ICU), ventilation, and number of ICU days. Clinician interviews provided additional insight into the telehealth implementation. Findings: One-quarter of the patients received a telehealth visit. Half were admitted to the ICU, and one-third received ventilation. Regression models did not identify statistically significant differences in transfer to the ICU, number of ICU days, and ventilation between patients with and without telehealth visits. Older age and increased respiratory rate were associated with higher odds of ICU admission. Patients with a cough were associated with lower odds of ventilation and fewer ICU days. Discussion: Implementation challenges included difficulties associated with assisting patients with operating the tablets. However, clinicians noted that there was a great benefit to patients being able to see an unmasked physician. Furthermore, the telehealth program proved to be a viable strategy for connecting patients in isolation with their families. Findings can inform the future development of inpatient telemedicine strategies.

The University of Alabama at Birmingham COVID‐19 Collaborative Outcomes Research Enterprise: Developing an institutional learning health system in response to the global pandemic

“…For example, reorganizing human resources within the CCTS, COERE, and Informatics Institute supported the development of the scientific and data gateway processes. The results from these processes where then used to inform clinical practices on campus at the UAB hospital 21,24 …”

“…By design, components of the LHS framework were populated by interdisciplinary individuals who had not previously worked together, drawing from the health system learning and academic research engines. Speaking to the value of these new collaborations, on the initial call, a frontline provider commented, “I am not a researcher, but I have a lot of questions.” This provider led the implementation of inpatient telehealth approaches to facilitate remote clinician rounds within the UAB hospital system and support conservation efforts for personal protective equipment during national shortages throughout the pandemic 21 . Evaluation of this inpatient telehealth approach, facilitated by the COVID‐19 CORE, answered the provider's questions on the effectiveness, safety, and outcomes of this approach 21 .…”

“…Data derived from this process were used in local level decision-making, informing the implementation of inpatient telehealth approaches to facilitate remote clinician rounds within the UAB hospital system and support conservation efforts for personal protective equipment during national shortages throughout the pandemic. 21 The public health and community group determined local and state health department individual-level surveillance data related to COVID-19. These data were not immediately available for research The UAB Informatics Institute's Enterprise Data Warehouse (EDW), i2B2 framework, and data query tool contributed an existing infrastructure for the extraction and management of UAB Medicine health system data within the LHS framework.…”

“…21 Evaluation of this inpatient telehealth approach, facilitated by the COVID-19 CORE, answered the provider's questions on the effectiveness, safety, and outcomes of this approach. 21 As representation of frontline providers within the LHS increases, we anticipate greater agility within the LHS to prioritize their questions and to formulate a response that is representative and inclusive of their voices, questions, and concerns.…”

“…The health system data group compiled currently available data, classified as discrete elements in the electronic health record (EHR), amenable to data query vs unstructured elements requiring manual abstraction; the latter of which were abstracted following a coordinated gateway process (Figure 3). Data derived from this process were used in local level decision‐making, informing the implementation of inpatient telehealth approaches to facilitate remote clinician rounds within the UAB hospital system and support conservation efforts for personal protective equipment during national shortages throughout the pandemic 21 …”