P1003 - Evaluating Clinical and Educational Experiences with Telemedicine in a Multidisciplinary High-Risk Infant Follow-Up Program due to the COVID-19 Response

Program Goals:

Prior to COVID-19, infants at increased risk of poor growth, feeding difficulties, and neurodevelopmental disabilities due to prematurity or other congenital diagnoses were evaluated in-person during the course of one patient encounter by our multidisciplinary team, consisting of two general pediatric providers (MD and PNP), one PGY-3 resident physician, and an MA, RN, RD, LCSW, and SLP. The pandemic response created the need for our team to rapidly convert evaluations to a telemedicine platform while maintaining a robust resident educational experience.

Program goals for transitioning to a telemedicine platform were 1) to maintain access to a multidisciplinary evaluation for patients and families and 2) continued involvement of residents in patient encounters. Three telemedicine platforms supported by our institution were trialed to assess which one best-supported multi-participant use. The clinical flow model used by the program during in-person visits was also adapted for the telemedicine platform. This included a virtual pre-clinic huddle with the multidisciplinary team, followed by the RN Program Coordinator introducing team members and outlining the sequence of the virtual visit for each patient and family in real-time.

Evaluation:

The multidisciplinary team was offered a voluntary anonymous online survey about their experience with telemedicine. 88 % of respondents (n=9) had no previous telemedicine experience. Respondents had higher rates of satisfaction for return visits compared to new visits (Figure 1). Disadvantages of virtual visits included limited physical assessment of patients (including accurate measurements) and decreased communication between residents and staff outside of the pre-clinic huddle. Advantages of virtual visits included improved access for families and added insight about social determinants of health observed in the home setting. 100% of resident respondents to date (n=3) rated their overall telemedicine educational experience as average to above average and rated the quality of feedback as unchanged between virtual and in-person visits. Comparison of encounter data between April 2019 and April 2020 showed similar fill rates and no-show rates (Table 1). At the time of presentation, we anticipate comparing encounter data from April through August in 2019 and 2020 and having data from an additional 20-24 residents.

Discussion:

Since transitioning to a telemedicine platform in response to COVID-19, our high-risk infant follow-up program has maintained patient access to a multidisciplinary evaluation and continued to involve residents in virtual patient encounters. Planned adaptations include streamlining the use of technology to preserve resident autonomy in decision- making. The program will continue to advocate with state Medicaid to expand provision of home infant scales to improve patient assessment. Ongoing analysis of patient/family satisfaction along with studying the advantages and disadvantages of the telemedicine platform between multidisciplinary members and residents will allow for development of best practices for the use of telemedicine in an educational setting.