ABSTRACT
Study Objectives: During the COVID-19 pandemic, there was a gap in adequate discharge counseling for COVID-19 patients from the emergency department due to high patient volumes and constantly changing guidelines. Medical students were also restricted from clinical areas for safety, compromising their clinical experience. We piloted a novel program in which medical students served as virtual discharge counselors for COVID-19 patients via teleconference. This program allowed patients to receive dedicated counseling on their COVID-19 diagnosis. Students had a safe clinical experience while clinical staff could simultaneously provide direct patient care and increase ED efficiency. Methods: Students were trained with a standardized protocol and a discharge script. Counseling included diagnosis, supportive care with medication dosing, quarantine instructions, return precautions, follow up, and the ability to ask questions. Counseling was provided via secure video conference integrated in the electronic health record (EHR), in the patient’s preferred language. Results: Over an 18-week period, 45 patients were counseled for a median of 20 minutes (range, 7 to 39 min). 58% of patients spoke English;35% spoke Spanish;and 7% additional languages. Median times for discharge counseling were 16 minutes, 23 minutes, and 18 minutes, respectively (p = 0.015). The 72-hour ED revisit rate was 0%, versus 4.2% in similarly-matched, not counseled COVID-19 patients. Medical students (n= 16) believed this project increased their confidence when speaking with patients (90% strongly agreed or agreed) and that it was a worthwhile experience (100% strongly agreed or agreed). Lastly, 80% strongly agreed that they would volunteer again, and similarly, 80% indicated that this was their first telemedicine experience. Conclusion: Our novel discharge program provided patients extensive counseling in that preferred language that would not otherwise be possible in an urban ED setting amidst a pandemic (or even routine ED operations). Medical students received a safe clinical experience that improved their communication skills. Due to its success, this program was scaled across three additional ED sites, and ten additional counseling diagnoses were added. The program has now accrued over 100 medical and nursing student participants. This project has proven to be sustainable and is currently on- going as part of the emergency medicine medical student curriculum.