Background: The increasing incidence of COVID-19 infection has challenged health care systems to increase capacity while conserving personal protective equipment (PPE) supplies and minimizing nosocomial spread. Telemedicine shows promise to address these challenges but lacks comprehensive evaluation in the inpatient environment. Objective: The aim of this study is to evaluate an intrahospital telemedicine program (virtual care), along with its impact on exposure risk and communication. Methods: We conducted a natural experiment of virtual care on patients admitted for COVID-19. The primary exposure variable was documented use of virtual care. Patient characteristics, PPE use rates, and their association with virtual care use were assessed. In parallel, we conducted surveys with patients and clinicians to capture satisfaction with virtual care along the domains of communication, medical treatment, and exposure risk. Results: Of 137 total patients in our primary analysis, 43 patients used virtual care. In total, there were 82 inpatient days of use and 401 inpatient days without use. Hospital utilization and illness severity were similar in patients who opted in versus opted out. Virtual care was associated with a significant reduction in PPE use and physical exam rate. Surveys of 41 patients and clinicians showed high rates of recommendation for further use, and subjective improvements in communication. However, providers and patients expressed limitations in usability, medical assessment, and empathetic communication. Conclusions: In this pilot natural experiment, only a subset of patients used inpatient virtual care. When used, virtual care was associated with reductions in PPE use, reductions in exposure risk, and patient and provider satisfaction.
Bibliographical noteFunding Information:
Grant UL1TR002494 from the National Institutes of Health's National Center for Advancing Translational Sciences. Additional funding was obtained from the Agency for Healthcare Research and Quality (AHRQ HS26732-01).
Author CT is supported by the Agency for Healthcare Research and Quality (AHRQ), Patient-Centered Outcomes Research Institute (PCORI), grant K12HS026379 and the National Institutes of Health’s National Center for Advancing Translational Sciences, grant KL2TR002492. The content is solely the responsibility of the authors and does not necessarily represent the official views of AHRQ, PCORI, or Minnesota Learning Health System Mentored Career Development Program (MN-LHS). The other authors have no conflicts to declare.
© Sean Legler, Matthew Diehl, Brian Hilliard, Andrew Olson, Rebecca Markowitz, Christopher Tignanelli, Genevieve B Melton, Alain Broccard, Jonathan Kirsch, Michael Usher. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 29.04.2021. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on https://www.jmir.org/, as well as this copyright and license information must be included.
- Hospital medicine
- Mixed methods
PubMed: MeSH publication types
- Journal Article
- Observational Study