The ID Physician Is Out: Are Remote ID E-Consults an Effective Substitute?
Open Forum Infectious Diseases
; 8(SUPPL 1):S401-S402, 2021.
Article
in English
| EMBASE | ID: covidwho-1746407
ABSTRACT
Background. Telemedicine (TM) can provide specialty ID care for remote and underserved areas;however, the need for dedicated audio-visual equipment, secure and stable internet connectivity, and local staff to assist with the consultation has limited wider implementation of synchronous TM. ID e-consults (ID electronic consultations or asynchronous™) are an alternative but data are limited on their effectiveness, especially patient outcomes. Methods. In the setting of the COVID-19 pandemic and ID physician outage, we were asked to perform ID e-consults at a 380-bed tertiary care hospital located in Blair County, PA. We performed retrospective chart reviews of 121 patients initially evaluated by ID e-consults between April 2020 and July 2020. Follow-up visits were also conducted via e-consults with or without direct phone calls with the patient. Key patient outcomes assessed were length of stay (LOS), disposition after hospitalization, 30-day mortality from initial ID e-consult and 30-day readmission post-discharge. Results. The majority of patients were white males and non-ICU (Table 1). The most common ID diagnosis was bacteremia (27.3%, 33/121), followed by skin and soft tissue infections (15.7%, 19/121) and bone/joint infections (14.9%, 18/121) (Figure 1). Table 2 shows patient outcomes. Average total LOS was 11 days and 7 days post-initial ID e-consult. 48.7% (59/121) of patients were discharged home and 37.2% (45/121) to a post-acute rehabilitation facility. 2.5% (3/121) of patients required transfer to a higher level of care facility;none of which were to obtain in-person ID care. The index mortality rate was 3.3% (4/121), which appears to be lower than published data for in-person ID care. The 30-day mortality rate was 4.1% (5/121), which is also comparable to previously reported for ID e-consults. 25.6% (31/121) of patients required readmission within 30 days but only 14.0% (17/121) were related to the initial infection. Conclusion. We believe that this is the first report of the implementation of ID e-consults at a tertiary care hospital. Mortality rates appear to be comparable to in-person ID care. In the absence of in-person ID physicians, ID e-consults can be a reasonable substitute. Further study is required to compare performance of ID e-consults to in-person ID consults.
adult; bacteremia; bone infection; clinical assessment; conference abstract; controlled study; coronavirus disease 2019; follow up; hospital discharge; hospital readmission; hospitalization; human; infectious arthritis; length of stay; major clinical study; male; medical record review; mortality; mortality rate; outcome assessment; pandemic; physician; rehabilitation; retrospective study; skin infection; soft tissue infection; tertiary care center
Full text:
Available
Collection:
Databases of international organizations
Database:
EMBASE
Type of study:
Experimental Studies
Language:
English
Journal:
Open Forum Infectious Diseases
Year:
2021
Document Type:
Article
Similar
MEDLINE
...
LILACS
LIS