Telemedicine Response To Covid-19 Surge In New York City: How Emergency Department Telemedicine Changed With The Curve

Study Objectives: To describe how a major medical system in New York City (NYC) leveraged emergency department telemedicine services to meet the demands of COVID-19 New York-Presbyterian Hospital System (NYP) is comprised of 10 hospitals in the greater NY metro area, including Weill Cornell Medicine (WCM) and Columbia University Irving Medical Center (CUIMC) The EDs at WCM and CUIMC began adopting telemedicine in 2016 and were well positioned to leverage these tools in response to the COVID-19 surge in March and April of 2020 Methods: Each of these areas saw telemedicine programs expanded or augmented: 1) Virtual Urgent Care (VUC);2) In-ED-based telemedicine;and 3) Post-ED follow-up care Results: 1) Virtual Urgent Care (VUC): Our VUC program saw a 20-fold increase in patient volume, with over 300 patients per day at the peak Through partnership with NYC 911, calls were also redirected from dispatch to the VUC program to help decompress that system To meet demand, staffing was increased 20-fold Redeployed physicians from idled areas of the hospital and advance practice providers were rapidly onboarded through a combination of WebEx training sessions, remote shadowing, cognitive aids, and real-time clinical support from seasoned ED virtual care providers in a group chat that allowed for both real time and asynchronous decision support from experienced emergency physicians Most callers to virtual urgent care reported viral symptoms and COVID-related concerns Information was disseminated according to guidelines and local resources and was updated daily and synchronized across the enterprise VUC provided remote treatment, defraying countless in-person visits, and also allowing for escalation to in-person care where needed 2) In-ED-based telemedicine: Within the ED, our existing tele-medical screening exam was redesigned to help identify patients who could undergo a rapid treat and release without requiring a nurse resource This triage-based system helped to rapidly discharge the worried well, minimizing their exposure to illness, and helped to reduce person-to-person transmission within the ED In addition, pan-tilt-zoom video carts in isolation rooms facilitated staff communication with patients and avoided unnecessary exposures or PPE use 3) Post-ED follow-up care: To decompress the ED and hospital, an enterprise-wide pathway was created that risk stratified patients with COVID-like illness in the ED and allowed for discharge home of patients with moderate exertional hypoxia Appropriate patients were sent home with pulse oximeters and oxygen concentrators A telemedicine remote patient monitoring pathway was created that provided daily focused virtual respiratory exams for seven days and returned patients to the hospital when needed This pathway provided a safety net for over 1,000 patients discharged from the ED under crisis conditions who were at risk for deterioration at home Conclusion: The health care crisis associated with the COVID-19 peak of illness led to collaborative innovation within the NYP hospital system EDs Out-of-hospital telehealth care served many, eliminating the immediate need for ED care and burden on the EDs Virtual communication minimized infection spread within the ED Remote patient monitoring protected the safety of patients discharged from the ED Further study of the implications of these innovations on patient safety and public health are needed