207 Virtual Powers of Observation: A Telemedicine Pathway for the Suspected COVID-19 Patient

Study Objectives Prior to COVID-19, telemedicine and its applications to the emergency department (ED) had made significant inroads towards remote evaluation and care During the local peak of the COVID-19 pandemic in NYC, telemedicine patient encounters for suspected COVID-19 symptoms dramatically increased In response, pathways were developed to promote a standardized telemedicine approach to remote evaluation and assessment of suspected COVID-19 patients Methods: A pathway was developed and implemented at two academic emergency departments in New York City that collectively had approximately 8300 telemedicine visits for suspected COVID-19 from March 2020- June 2020 Protocol was developed via an expert consensus panel of 4 board certified emergency physicians and 2 pediatric emergency physicians, all with telemedicine training/administrative roles Results: The pathway was initiated for any telehealth patient with suspected COVID-19 symptoms (cough, fever, shortness of breath, bodyaches) A standardized history solicited known or suspected risk factors for worse prognosis including: age\u003e50, cardiovascular or lung disease, obesity, immunosuppression, living alone) as well as a focused assessment of symptom severity and exercise tolerance An exam at rest included visual counting of breaths along with instruction on palpation of radial pulse Saturation was included if pulse oximetry was available If exam at rest was reassuring, providers were instructed to repeat the respiratory assessment on exertion by having the patient walk in place briskly for one minute Patients with severe illness, defined by resting or exertional respiratory rate greater than 30 and/or oxygen saturation less than 90% were instructed to go to the ED Patients with moderate illness defined by exertional metrics of respiratory rate less than 22, oxygen saturation greater than 94 percent and heart rate less than 125 were discharged from the virtual urgent care visit with a repeat telehealth follow up call at either 12 or 24 hours depending on the number of risk factors Patients without risk factors and with reassuring respiratory assessment were discharged from the telemedicine encounter with reassurance and standard discharge precautions for escalation of care Conclusion: Designing and disseminating a standardized pathway helped provide a framework to approach patients suspected of COVID-19 over telemedicine Future work focusing on patient outcome data, will help guide and refine any standardized telehealth approach to the COVID-19 suspected patient