ヘルスケアコミュニケーションジャーナル オープンアクセス

抽象的な

Rapid Adoption of Telemedicine for Pre-Operative Optimization during the COVID-19 Pandemic

Maureen Keshock*, Sarah A. Vogler, Scott R. Steele, Piyush Mathur, Kenneth C. Cummings

Background: Despite the abundance of publications regarding the COVID-19 pandemic, there is little information regarding the pre-surgical optimization process and telemedicine visits in a large healthcare system. The purpose of this research is to report on the use of an automated algorithm to triage patients into virtual visits versus standard in person visits.

Methods: In order to triage appropriate patients to a virtual PACC visit, an algorithm was developed and embedded in our electronic health record (EHR). The algorithm was named the “PACC Triage Questionnaire” and takes into account the procedural risk as well as patient comorbidities. The surgeon’s office completes this questionnaire within the patient’s EHR and at completion a recommended PACC visit type is automatically generated. Thus the patient is triaged to a visit type of PACC in person visit, PACC virtual visit, or no PACC visit needed. This ‘PACC Triage Questionnaire’ replaced a far more tedious PACC questionnaire and maximized the use of our EHR technology by automating the triage process to a specific visit type.

Results: Overall, initial results from the triage tool recommended “No PACC visit” for 43% of patients, “In Person PACC visit” for 41% of patients, and “Virtual Visit PACC” for 16% of patients. Patient and caregiver acceptance has been high. In the 4 months period prior to the implementation of this questionnaire, approximately 33% of all PACC visits were performed virtually. In the 4 months period after implementation, approximately 30% of PACC visits were performed virtually. The disparity between the actual number of virtual visits and the recommendations from the questionnaire can be largely explained by the process of deploying the PACC questionnaire. Utilization began in selected departments then was expanded (but is not yet universal). Those services not yet using the questionnaire choose the appointment type they believe to be appropriate. Thus, over time, we expect the actual percentages to more closely align with the recommendation of the questionnaire. Additionally, the relatively high number of “No PACC” recommendations likely stems from the initial rollout including a higher proportion of healthy patients undergoing low risk procedures. As the questionnaire continues to be implemented, inclusion of more complex patients will likely lower the number of “No PACC” recommendations.

Conclusion: Having the algorithm embedded in the EHR and initiated in the surgeons’ offices directed more patient traffic to a virtual visit which, in the time of a pandemic, benefits society as a whole. Reassessing triage recommendations over time as more patients are screened will allow refinement of the questionnaire. Future enhancements include deploying the PACC Questionnaire to our online patient portal (e.g. “MyChart”) and further automating the scheduling process. This research did not receive any specific grant from funding agencies in the public, commercial, or not for profit sectors.