Procedure Based Telehealth Utilization in General Surgery

Introduction: After COVID-19, telehealth (TH) capabilities expanded relaying patient satisfaction, time savings, and efficient access to care. We hypothesize standardized TH scheduling processes improves TH utilization without increasing adverse events (AE). Method(s): The Telehealth Utilization Quality Improvement Initiative was conducted from 8/2021-1/2022 in the general surgery clinic. 50 visits pre-implementation and 70 visits post-implementation were audited over the study period. Stakeholders were engaged including faculty, clinic coordinators, and administrative staff to identify current workflows and potential interventions, targeting outpatient elective procedures. Process mapping outlined current TH scheduling workflows. Outcomes such as percent TH scheduled in clinic, in addition to cost, and adverse patient events were collected post-implementation. Result(s): Preliminary data revealed 50 patients who underwent elective outpatient surgeries, all appropriate for TH postoperative follow-up visits. Overall, the pre-implementation TH scheduling rate was 32%. TH was schedule dafter surgery in the preintervention group. The intervention required TH postoperative appointments to be scheduled in clinic at the time of surgery scheduling with TH being the default postsurgical appointment for a standardized list of eligible procedures. After implementation, 95% of patients undergoing elective, outpatient general surgery procedures were scheduled for a TH visit with 83% of patients completing their follow up via TH.This resulted in increased revenue of $30,431 in billable visits due to increased clinic visit availability. No AE were seen. Conclusion(s): Standardizing TH scheduling based on procedure improves the utilization of TH in outpatient, elective general surgery procedures resulting in improved clinic efficiency, increased revenue, and no AE.

Need to Improve Minority Representation through COVID-19 Community Research Partnership

Background. Minorities are often unrepresented in research, which limits equity in healthcare advances. The racial and ethnic disparities in outcomes of individuals infected with COVID-19 highlight the importance of inclusivity in research to improve public health measures. Methods. We performed a descriptive analysis of the racial and ethnic distribution of children enrolled in our COVID-19 Community Research Partnership (CRP) study, a syndromic and serological surveillance study of children aged 2 - 17 years receiving care at three healthcare systems spanning North and South Carolina. Syndromic surveillance involved daily symptom reporting using a webbased monitoring application. Participants consenting to serological surveillance were mailed at-home tests sampling finger prick capillary blood. In-person and electronic recruitment efforts were conducted in English and Spanish. At one of the study sites, we compared the racial/ethnic distribution of enrolled children to the racial/ethnic distribution of all children who received care at the same site during the same timeframe. We compared the racial/ethnic distribution of participants who ultimately submitted samples for serological testing compared to those who consented to serologic testing. Results. At total of1630 children were enrolled from April 2, 2021 - June 8, 2021. Most children were > 5 years old, 50.2% were female, and 88.5% were from mostly urban counties (Table 1). Of enrolled children, 4.2% were Hispanic, 8.2% were black, and 81.6% were white (Table 2). Among 135,355 unique children who received care at the institution during the same time, 12.4% were Hispanic, 23.0% were black, and 63.1% were white. Of 1552 participants who consented to serologic testing, 4.4% were Hispanic, 8.1% were black, and 81.8% were white (Table 3). To date, 242 children submitted serologic samples;4.1% were Hispanic, 5.0% were black, and 85.5% were white. Conclusion. Despite efforts to recruit a diverse group of children, the proportion of minorities enrolled in our COVID-19 surveillance study underrepresents the targeted population. Ongoing efforts will work to identify barriers and facilitators to research participation among minority families.

ISOL-AID, ART and wellbeing: Posthuman community amid COVID-19

In the isolating times of COVID-19, digital live streaming has been a key means through which artists connect with their audiences/community and audience members access live art and music. With performances mediated through digital live stream, artists and audience members alike are experimenting with strategies for connection, and indeed, for survival. This reconfiguration of sociality, of the liveness of community, threatens to endure beyond the pandemic. The Instagram Live music festival ‘Isol-AID’, which we examine as a case study in this chapter, prompts a discussion around arts accessibility as a measure of public health and wellbeing. Building on literature about social prescribing, we suggest that Instagram Live engages therapeutic forms of arts practice, and as such, could be offered as a new digital health resource. Using a critical posthumanist perspective, we think-through Instagram Live and streamed performance as posthuman assemblages to highlight the importance of non-human actants (such as phones, wifi, colours, sounds) in the production of the feeling of community, which is a social determinant of health. These creative methods of expression and connection encourage discussion around the importance of the arts in community health and wellbeing, a conversation that could not be more relevant than in the socially isolated world that is, this global pandemic. © 2021 selection and editorial matter, Deborah Lupton and Karen Willis.