NEW YORK CITY COVID-19 CONSULTS: AN ALGORITHM FOR SAFE, EFFICIENT, QUALITY CARE

ABSTRACT

INTRODUCTION AND OBJECTIVE: COVID-19 created immense anxiety amongst caregivers and unique strain on healthcare resources which is ongoing. We created a protocol to address this by examining the nature of consults (C) during the pandemic, describe which C needed to be managed in-person, and demonstrated that remote management of many C is appropriate. METHODS: A REDCAP database was used over a six weeks to record urology C at our institution. Data included COVID-status of the patient, reason for C, patient characteristics, and type of intervention required. RESULTS: We received 154 C during the study period. 53% were evaluated in person. 47% were managed remotely. Most common reasons for C were difficult foley catheter placement (21%), obstructing stones(16%), retention (14%) and hematuria (12%). Less common entities included priapism (3%) and Fournier's gangrene (3%). At the time of C 58% were COVID negative, 30% were COVID positive. After evaluation, 44% of C needed no intervention, 27% required a foley, 8% required bladder irrigation and 4% required stenting or nephrostomy placement. Outcomes of those evaluated remotely did not reflect any issues with the care rendered. Fig 1 represents C requests and Fig 2 interventions. CONCLUSIONS: This study showed a higher percentage of C during COVID-19 requiring intervention compared to pre-COVID literature which we successfully identified. 44% did not require acute in-patient intervention. We have shown there is an important role that remote care can and should play in our specialty. Not all C need hands on intervention and studies such as this will result in a safe and logical algorithm for the management of C. With this approach, it became very apparent that not all C are appropriate. This can lead to enhancing the skill set of other house staff. Lastly, the lack of urgency of a large percentage of what we are consulted for becomes apparent. In the face of demands for decreased work hours amongst house staff, strained resources during the pandemic, and the anxiety of the unknown of this virus, we have been able to redefine how C services are delivered.