Pediatric gastroenterology tool kit for telemedicine during the COVID-19 pandemic

ABSTRACT

Background/Significance: Telehealth (TH) services rapidly expanded during the COVID-19 pandemic. This rapid deployment precluded the opportunity for initial planning of implementation strategies. Purpose and Goals To understand the needs of nurse practitioners and examine TH procedures and interventions designed to promote high quality, equitable health care for pediatric patients with gastrointestinal concerns. Methods: The Plan, Do, Study, Act model was used. Survey data from providers and families were collected and analyzed. They were further illuminated through iterative dialog across the research team to determine the quality and efficiency of TH. Findings: A toolkit of strategies for promoting the quality and efficiency of TH was created according to the three domains of health equity availability, accessibility, and acceptability. We reached the following conclusions: No specific telehealth training and competencies have been established for NPs. Interpreters are needed for patients who have language barriers and hearing impairment. Scheduling flexibility and revenue needs should account for increased time needed for complex patients. Technology needs to be current for NPs and patients to prevent audiovisual failures. Reading level of introductory TH emails need to be at a 5th grade literacy level and should be available in different languages. Ideally families should have access to a scale at home since accurate weights are an integral part of the GI visit. Patient's location should be matched with location of clinic when scheduling appointments so that follow up care can be provided easily when visits are in person. Physical examination is limited and laboratory orders and stool/urine collections require a prescheduled appointment. Implications/Next Steps: Development and implementation of comprehensive education to address the above findings. Ongoing collaboration with virtual visit team and AAs to find systems to proactively arrange for interpreters and flexibility with allotted time for visits. Provide alternate methods to support families with audio/visual difficulties;IT/help desk telephone number and option of in-person visits. Introductory email that meets literacy standards now includes specific expectations, including all patient visits need to be done in a private setting, presence of patient for the entire visit, and weight to be obtained before visit. Development and provision of alternative communication when audio connectivity fails, ie flashcards to alert family and suggest solutions (signing in/out of appointment) to preserve full audio/visual visit capabilities. Develop algorithm to prioritize in person visits, based on acuity of presenting illness and complexity of patient.