ABSTRACT
Objective: To use a multidisciplinary quality improvement (QI) approach for telehealth visits to facilitate the care of people with cystic fibrosis (CF) in our pediatric program in the midst of a pandemic. Background/Significance: Care guidelines recommend that people with CF are seen quarterly with multidisciplinary (MDR) visits to monitor health and well-being. In 2020, the COVID-19 pandemic posed a threat to this care model as routine ambulatory clinics were closed and in-person visits were quickly converted to telehealth visits. Our CF program utilized Zoom technology to facilitate our MDR clinical care approach with telehealth. Methods: Our MDR team consisted of physicians, nurses, nurse practitioners, social workers, dietitians, physical therapists, and administrators. We collaborated with our parent QI advisors, the parents of two young teens with CF. We created a process map for telehealth visits and identified barriers. We adapted a pre-existing, pre-visit planning (PVP) tool to telehealth visits. The modified PVP form included: information for the next visit;SARS-CoV-2 exposure and COVID-19 risk;review of equipment;sick plan;and details for communications with the CF center. Our weekly pediatric MDR meetings were used to discuss patients scheduled for the telehealth program and identify potential communication barriers to parent and patient use of the system. Appropriate staff members were identified to join the Zoom visit. The CF nursing coordinator (1) arranged Zoom visits with identified administrative staff;(2) provided education during the visit;(3) arranged for out-patient testing and followed the results;(3) coordinated CF consults with endocrine, diabetic nurse educators, and the gastroenterologist;(4) provided sick plans for families, and (5) communicated with homecare companies for respiratory equipment. The team sent post-visit surveys to all families who had telehealth visits. Results/Findings: We began offering telehealth visits 3/22/20 through a hospital-wide platform and added Zoom visits 3/29/20 which better suited the multidisciplinary care model where different members of the MDR team could join. Physical therapy was unable to participate in telehealth visits. From 3/29/2020 to 5/29/2020 we provided 144 virtual visits, 73 of these virtual visits were Zoom visits (51%) with social work participating in 67%, nutrition 73%, and nursing 100%. Conclusion/Next Steps: We rapidly established a telehealth program using Zoom visits to assess and provide CF care during the COVID-19 crisis. Patients, families and staff were satisfied with their telehealth visits. The next phase of the telehealth program will include both telehealth and in-person visits. We will improve our program by addressing the barriers we have identified, such as (1) the need to develop web-based learning tools for patients and parents, and (2) the need to ensure a nursing presence on the telehealth visit. A nursing presence will help alleviate fears about telehealth (particularly during the pandemic) and address frequent patient needs: (1) checking respiratory equipment such as nebulizers, compressors, and vest, (2) creating a sick plan, (3) following up on lab work, (4) checking prescription refills, and (5) coordinating future care.