Operationalizing multidisciplinary cleft and craniofacial clinic on zoom: Lessons from COVID-19

ABSTRACT

Background/Purpose: Multidisciplinary and longitudinal care are key attributes of cleft teams. During COVID-19, all cleft centers had to adapt to deliver care while observing new regulations on physical distancing. We used Zoom as a telehealth platform and replicated our native in-person multidisciplinary team workflow to a virtual format. We preserved key aspects of our in-person clinic and this virtual workflow using Zoom was so successful, that we continue to utilize the telehealth option for several key advantages it provides. Methods/Description We used a telehealth Zoom platform with patient-specific secure password access. The Cleft team coordinator served as the Zoom host who preassigned all specialists into individual breakout rooms on the Zoom application. After the patient joins the main session, the Cleft Team Coordinator can then navigate the patient through the different breakout rooms with various specialists via the Breakout Rooms tab that is seen in the bottom right of the call. Results: Our Cleft Clinic carried out 33 in-person patient consultations before the COVID-19 shutdown in Boston (January 2020-February 2020). As Covid-19 regulations mandated closure of all nonessential clinical activity, we operationalized the telehealth clinic. During this time, we saw 10 patients via the telehealth platform (March 2020-May 2020). As conditions evolved, we incorporated telehealth in a hybrid model, where we saw a total of 43 patients (June 2020-August 2020), of which 19 (44%) were in person and 24 (56%) were via the telehealth platform. Conclusions: Implementation of a virtual cleft and craniofacial clinic has proven to be an effective substitute for the native in-person patient experience. Ongoing work will include patient-reported survey of these clinic experiences. The Zoom telehealth system negated the distance between provider and patient and allowed our cleft team to broaden our reach to international patients. Furthermore, young patients with cleft malformations can by accompanied by family members in the same Zoom session even though the family members may not be physically together. This style of clinic also allowed greater access to specialists who are still asked by the hospital to work remotely. We found the ability to set individual Break out rooms for each specialist to be a key feature available on Zoom but not in other telehealth applications. We describe this Zoom telehealth workflow as a framework to integrate efficient multidisciplinary and longitudinal care in the treatment of patients with cleft abnormalities during COVID-19 but also as a paradigm shift in cleft care delivery.