Success and Challenges of Telemedicine in the Care of Pediatric Heart Transplant Patients During the COVID-19 Pandemic: OJNI

ABSTRACT

Background: During the COVID-19 surge and shutdown of New York City from March 2020 through May 2020, we transitioned to telemedicine to provide routine and urgent care to our pediatric heart transplant patients. The effectiveness of telemedicine in this population has not been described. Methods: A retrospective cohort study was conducted at the Children’s Hospital at Montefiore.  Electronic health records of all pediatric heart transplant patients who received care from January 3, 2020, to August 31, 2020 were queried. Data collected included frequency of telemedicine visits, in person, and emergency room visits, hospitalizations, immunosuppression levels requiring adjustment, and out-of-window patient follow-up. The proportion of immunosuppression levels out of range was compared among four identified groups by chi-square analysis. Results: During the shutdown period (March 13, 2020, to May 12, 2020) there were 54 telemedicine visits 61% routine and 39% urgent. Five (24%) urgent telemedicine visits justified an in-person follow-up three clinic visits, two ED visits, one patient hospitalized.  During the post-shutdown period 1 (May 13, 2020, to June 20, 2020) when in person visits resumed, nine patient visits were out of window for routine follow-up, with a median of six weeks delayed.  Immunosuppression levels were not therapeutic in 29% of patients in the pre-shutdown period (January 3, 2020, to March 18, 2020) compared to 46% during the post-shutdown period 1 (p=0.06). By post-shutdown period 2 (June 12, 2020, to August 31, 2020), out of range immunosuppression levels had returned to pre-shutdown out of range levels (25% of patients) with a p=0.6. The percent of immunosuppression levels out of range between post-shutdown period 1 and post-shutdown period 2 was statistically significant (p=0.04). Conclusion: Telemedicine can be utilized to stay connected to patients when routine in person care is disrupted.  The higher percentage of patients with immunosuppression levels out of range seen during post COVID-19 shutdown period 1 reinforces the importance of routine immunosuppression level surveillance.