ABSTRACT
The COVID-19 pandemic created an unprecedented shortage of personal protective equipment (PPE) for healthcare workers-especially respirators. In response to a lack of commercial respirator equipment, a multidisciplinary prototyping hackathon was held and the key components required to develop an inexpensive, scalable "COVID-19 reusable elastomeric respirator" (RER-19) were identified. Available hospital supplies were assessed based on their published technical specifications to meet each of the key component requirements. The fully assembled prototype was then validated through user testing, and volunteers underwent standard fit testing with cardiopulmonary monitoring while wearing the RER-19 in a small pilot study. Multiple social media platforms were then used to disseminate educational information on respirator assembly, use, and maintenance. Here, we present our institution's initial experience with prototyping to meet a specific healthcare challenge, in combination with prompt dissemination of information to educate and empower healthcare workers in the face of a critical PPE shortage during an unprecedented and evolving pandemic.
ABSTRACT
Background: In response to the SARS-CoV-2 pandemic, the multidisciplinary care of cancer patients has rapidlyevolved. This study aims to determine utilization trends of in-person, telephone, and video visits, before and afterthe California shelter-in-place (SIP) orders on 3/19/20, and assess perspectives of cancer care providers ontelehealth. Methods: This study was conducted in 22 medical centers of a large integrated health care system. Utilization ofdifferent visit types in medical oncology (excluding infusion visits) was collected between 12/1/2019-5/24/2020, for atotal of 104,588 visits. Chi-square with Yates correction was used for p-values. Voluntary, anonymous electronicsurveys were sent to 276 cancer care providers measuring attitudes and experiences with telehealth. Overall, 68.8%responded: 101/128 medical oncologists (MedOnc), 34/37 radiation oncologists (RadOnc), 16/62 breast surgeons(Brst Surg), 18/28 breast oncology nurse navigators (OncNav), and 21/21 cancer survivorship advancedpractitioners (SurvOnc). Results: Comparing visit types prior to and after SIP, in-person visits went from 55.3% to 3.3%, telephone visitswent from 44.2% to 79%, and video visits went from 0.5% to 17.8% (p<.0001). Between 12/2019 and 05/2020, video visits increased from 0.42% to 31.3%. Telephone visits increased from 39.3 to a peak of 86.6% in 04/2020 andthen decreased to 63.7%. In-person visits dropped from 60.3% to 2.3% in 04/2020 and then increased to 5.0%(p<.0001). Satisfaction with telehealth was high: 87.1% of MedOnc, 91.2% of RadOnc, 68.6% of BrstSurg, 72.2% ofOncNav, and 90.4% SurvOnc providers were very or somewhat satisfied. Most providers preferred to increase ormaintain telehealth utilization after the pandemic: 84% of MedOnc, 85% of RadOnc, 81% of BrstSurg, 51% ofOncNav, and 90% of SurvOnc. Among most providers, highest cited benefits of telehealth included work from home, reduced commute, staying on time, flexible hours, and shorter visits. Commonly cited challenges includedconnection/equipment problems, need for physical exam, difficulty evaluating performance status, and in-personvisit required anyway. Of MedOnc, 11.8% responded that a patient suffered an adverse effect that could have beenprevented with in-person visit. In-person visits were thought to promote the strongest provider-patient connection, followed by video, telephone visits, and emails. MedOnc providers deemed in-person visits were needed for end-of-life discussion (49%), discussing a new diagnosis (47.1%), palliative care discussion (34.3%), and clinical trialenrollment (34.3%). Activities for which email or phone visits were most accepted included check-in pretreatment, survivorship planning/follow-up, and patient navigation. Conclusion: Overall, telehealth utilization has rapidly increased and is well accepted by various cancer careproviders. Addressing technical issues and tailoring visit type to specific activities may further promote telehealthadoption and satisfaction.