Reprinted from the Spring 2021 Issue of The Ohio Family Physician
By: Kate Szymanski, DO
University of Toledo Medical Center Department of Family Medicine
With the COVID-19 mortality rate estimated to be 21% of patients at extended care facilities (ECF),1 getting ahead of the virus by early identification is essential. According to the Centers for Disease Control and Prevention (CDC),2 there have been 19,432,125 national cases, and 614,031 confirmed in the state of Ohio as of December 30, 2020.3 Of these cases, 39,584 patients have been confirmed in Ohio’s extended care facilities, causing a unique stress on those facilities, staff, and physicians.4
Pivoting our physicians to a telehealth approach increased their access to multiple patient sites while eliminating the possibility of our physicians becoming a vector of COVID-19 infection. Telehealth, however, presented our group with unforeseen hurdles including, but not limited to, staffing, personal protective equipment (PPE) availability, hardware, software, and treatment of patients with the virus.
All of these challenges had to be met while maintaining the standard of care for our vulnerable patient population.
Telehealth visits require many resources and procedures that were not in place before this pandemic began.5 Hardware lacked the capacity to run the HIPAA-compliant software that allows us to see our patients. In many facilities, technology of this kind had never even been discussed, let alone used.
Several ECFs have in-house electronic medical records or paper charting that limits remote access. Administrators, directors of nursing, and physicians worked to find computers, retired cellphones, and tablets as an additional means of running software to facilitate communication and patient care.
As COVID-19 came into facilities, staffing became a growing challenge.4 Due to increased workloads, insufficient PPE, and increasing patient needs, the availability of staff to facilitate telehealth was another strain. Multiple levels of the care team stepped up to facilitate patient care in creative ways beyond their previous responsibilities. For example, medical aides and nutrition staff maximized PPE conservation and facilitated telehealth by bringing the technology to the patient bedside with meal tray passes and patient care activities. Cross training of all staff in telehealth technology will need to continue for the adoption of telehealth in the ECF.
As physicians, telehealth changed our approach to patient care by increasing our dependence on alternative methods of examination and feedback from others. Conversations with nurses, support staff, and the medical aides became vital for monitoring changes in patient health. For example, our nurses now use video chat to demonstrate physical exam findings and rely on the video resolution of the devices to see minute and diagnostic changes. Due to this new creative communication process, small changes seen by support staff, that may not have been previously reported, have become early clues to illness allowing the opportunity to provide intercession.
Telehealth provided easy and rapid availability of communication between physicians and other healthcare professionals, allowing for prompt intervention and more open communication. Medical interventions using telehealth, with close loop communication, improved team dialogue and cohesive performance. As we learn and grow through these unprecedented times, it will be important that we continue to work as one patient-focused care team. New cooperation levels and creativity from many areas of the care team have been called upon to help serve our patients. Multiple levels of the care team have assisted with telehealth, including finding resources, bringing the technology to the patient bedside, and facilitating conversations with patients and families.
Accelerated adoption of telehealth highlights the continued need for expanded funding and training in this setting. Sharing knowledge and resources will be pivotal to the sustained growth of the medical system in the ECFs. Hybrid models of care, with telehealth having a more predominant place in the ECF, can allow the physician to have more availability for patient evaluation and improve patient care.
References available on the Ohio Academy of Family Physicians website.