ABSTRACT
Telehealth drastically reduces the time burden of appointments and increases access to care for homebound patients. During the COVID-19 pandemic, many outpatient practices closed, requiring an expansion of telemedicine capabilities. However, a significant number of patients remain unconnected to telehealth-capable patient portals. Currently, no literature exists on the success of and barriers to remote enrollment in telehealth patient portals. From March 26 to May 8, 2020, a total of 324 patients were discharged from Mount Sinai Beth Israel (MSBI), a teaching hospital in New York City. Study volunteers attempted to contact and enroll patients in the MyChart patient portal to allow the completion of a post-discharge video visit. If patients were unable to enroll, barriers were documented and coded for themes. Of the 324 patients discharged from MSBI during the study period, 277 (85%) were not yet enrolled in MyChart. Volunteers successfully contacted 136 patients (49% of those eligible), and 39 (14%) were successfully enrolled. Inability to contact patients was the most significant barrier. For those successfully contacted but not enrolled, the most frequent barrier was becoming lost to follow-up (29% of those contacted), followed by lack of interest in remote appointments (21%) and patient technological limitations (9%). Male patients, and those aged 40-59, were significantly less likely to successfully enroll compared to other patients. Telehealth is critical for healthcare delivery. Remote enrollment in a telemedicine-capable patient portal is feasible, yet underperforms compared to reported in-person enrollment rates. Health systems can improve telehealth infrastructure by incorporating patient portal enrollment into in-person workflows, educating on the importance of telehealth, and devising workarounds for technological barriers.
ABSTRACT
Telehealth drastically reduces the time burden of appointments and increases access to care for homebound patients. During the COVID-19 pandemic, many outpatient practices closed, requiring an expansion of telemedicine capabilities. However, a significant number of patients remain unconnected to telehealth-capable patient portals. Currently, no literature exists on the success of and barriers to remote enrollment in telehealth patient portals. From March 26 to May 8, 2020, a total of 324 patients were discharged from Mount Sinai Beth Israel (MSBI), a teaching hospital in New York City. Study volunteers attempted to contact and enroll patients in the MyChart patient portal to allow the completion of a post-discharge video visit. If patients were unable to enroll, barriers were documented and coded for themes. Of the 324 patients discharged from MSBI during the study period, 277 (85%) were not yet enrolled in MyChart. Volunteers successfully contacted 136 patients (49% of those eligible), and 39 (14%) were successfully enrolled. Inability to contact patients was the most significant barrier. For those successfully contacted but not enrolled, the most frequent barrier was becoming lost to follow-up (29% of those contacted), followed by lack of interest in remote appointments (21%) and patient technological limitations (9%). Male patients, and those aged 40–59, were significantly less likely to successfully enroll compared to other patients. Telehealth is critical for healthcare delivery. Remote enrollment in a telemedicine-capable patient portal is feasible, yet underperforms compared to reported in-person enrollment rates. Health systems can improve telehealth infrastructure by incorporating patient portal enrollment into in-person workflows, educating on the importance of telehealth, and devising workarounds for technological barriers.
ABSTRACT
Background: A significant number of patients with severe respiratory failure related to COVID-19 require prolonged mechanical ventilation. Minimal data exists regarding the timing, safety, and efficacy of combined bedside percutaneous tracheostomy and endoscopy gastrostomy tube placement in these patients. The safety for healthcare providers is also in question. This study's objective was to evaluate the effectiveness and safety of combined bedside tracheostomy and gastrostomy tube placement in COVID-19 patients. Design and Methods: This is a single arm, prospective cohort study in patients with COVID-19 and acute respiratory failure requiring prolonged mechanical ventilation who underwent bedside tracheostomy and percutaneous endoscopic gastrostomy placement. Detailed clinical and procedural data were collected. Descriptive statistics were employed and time to event curves were estimated and plotted using the Kaplan Meier method for clinically relevant prespecified endpoints. Results: Among 58 patients, the median total intensive care unit (ICU) length of stay was 29 days (24.7-33.3) with a median of 10 days (6.3-13.7) postprocedure. Nearly 88% of patients were weaned from mechanical ventilation postprocedure at a median of 9 days (6-12); 94% of these were decannulated. Sixty-day mortality was 10.3%. Almost 90% of patients were discharged alive from the hospital. All procedures were done at bedside with no patient transfer required out of the ICU. A median of 3.0 healthcare personnel total were present in the room per procedure. Conclusion: This study shows that survival of critically ill COVID-19 patients after tracheostomy and gastrostomy was nearly 90%. The time-to-event curves are encouraging regarding time to weaning, downsizing, decannulation, and discharge. A combined procedure minimizes the risk of virus transmission to healthcare providers in addition to decreasing the number of anesthetic episodes, transfusions, and transfers patients must undergo. This approach should be considered in critically ill COVID-19 patients requiring prolonged mechanical ventilation.