Fellow Children’s Mercy Hospital Children’s Mercy Hospital Kansas City, Missouri
Introduction: Facilitated telehealth (FTH) is a method of telehealth that utilizes an off-site facility, in our case staffed with RN’s, who can facilitate a patient exam with video equipment, including otoscopy. Prior to the recent COVID 19 epidemic and the widespread use of non-FTH, some questioned whether FTH was an effective way to evaluate pediatric otolaryngology patients.The objectives of this study were to determine if FTH visits are satisfactory to families, to determine travel distance and time saved, to identify sub-types of patients for which a secondary in-person visit would be needed, and to grade the reliability of the video exam.
Methods: This was a prospective quality improvement project in patients seen in FTH clinics between 2017-19. Demographic data, travel time, distance, and need for referral for an in-person visit was collected. A family satisfaction survey was completed at the time of the visit. Video physical examinations of the patients, including video otoscopy, were recorded. Three pediatric otolaryngologists then scored the exams using a detailed scoring system or interrater reliability in the areas of ear, nasal, oral and neck examinations.
Results: Fifty-one families enrolled saved a mean of 108.6 miles (SD 90.0) and a mean of 95.2 minutes (SD 78.3). All 27 parents who participated in the survey agreed that the visit was satisfactory or better. Two of 56 patients were referred to our main location for a secondary in person visit. Interrater reliability was evaluated with video recordings of 52 patients. The mean concordance on all points of the scoring scale was 95.6% (SD 0.11).
Conclusion: Families were satisfied and saved both miles and time. A second visit was rarely needed. Video exams showed excellent inter-rater reliability