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Risk of Admission to the Emergency Room/Inpatient Service After a Neurology Telemedicine Visit During COVID-19 Pandemic - 13/08/21

Doi : 10.1016/j.pediatrneurol.2021.06.005 
Charuta Joshi, MBBS a, , Mona Jacobson, MSN, CPNP a, Lori Silveira, PhD b, Stephanie Shea, BS, MPAS, PA-C a, Michele Yang, MD a, Krista Eschbach, MD a
a Division of Pediatric Neurology, Children's Hospital Colorado, Anschutz Medical Centre, University of Colorado School of Medicine, Aurora, Colorado 
b Department of Pediatrics, Children's Hospital Colorado, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, Colorado 

Communications should be addressed to: Dr. Joshi; Pediatric Neurology; Director Pediatric Epilepsy Fellowship; Director-Outreach Services in Neurology; Childrens Hospital Colorado; 13123 E 16th Avenue; Aurora, CO 80045.Pediatric NeurologyDirector Pediatric Epilepsy FellowshipDirector-Outreach Services in NeurologyChildrens Hospital Colorado13123 E 16th AvenueAuroraCO80045

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Abstract

Background

We compared emergency department (ED) and overnight inpatient admission (admission) rates within eight weeks of home-based telemedicine visits during COVID-19 in 2020 with in-person visits (conventional visit) in 2019. This was a quality improvement project prompted by an adverse event after a telemedicine visit.

Methods

We reviewed all completed telemedicine and conventional visits from March 26 to June 1 of 2020 and 2019 to identify patients who required an ED visit or hospital admission within eight weeks after the visit.

Results

In 2020, the overall rate of ED visits of hospital admission within eight weeks of a neurology visit was less than 5%. Comparing 2020 with 2019: (1) cohorts were similar for age, payor, state of residence, medical complexity, recommendation for close follow-up, new medications, or new tests ordered; (2) it took longer to present to the ED (by 10 days) or to be hospitalized (by three days); (3) planned admissions were approximately 50% lower; (4) on multivariate analysis, risk factors for any ED/admission included a patient call within seven days before the ED/admission (P = 0.0004) or being seen by an epilepsy specialist (P = 0.02); (5) a presenting complaint of worsening symptoms had a lower odds ratio of subsequent ED visit/admission (P = 0.005).

Conclusions

Telemedicine is safe, with a similar likelihood of ED or hospital admission during the pandemic in 2020 versus before the pandemic in 2019. In 2020, even if patients described worse symptoms at the time of their clinic visit, the odds of ED or hospital admission were lower than in 2019, but those who called after the telemedicine visit were more likely to be seen in ED or require hospitalization.

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Keywords : Telemedicine, Emergency department visit, Admission, Safety, Risk, Hospitalization


Plan


 Funding source: None.
 Conflicts of interest: All coauthors have read and agreed to the content of the manuscript. There is no commercial involvement in the study design or manuscript preparation or no other conflicts of interest by any of the author.


© 2021  Elsevier Inc. Tous droits réservés.
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Vol 122

P. 15-19 - septembre 2021 Retour au numéro
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