Background: The onset of the global COVID-19 pandemic created innumerable challenges and demanded rapid innovation for perioperative medicine. In March 2020, in response to our institution’s expectations, our hospitalist-led preoperative medicine clinic rapidly pivoted to patient care via telehealth.
Purpose: Before the pandemic, our hospitalist-led preoperative medicine clinic was already in the early planning stages to initiate a small volume of telehealth visits to meet the care needs of geographically remote and/or disadvantaged patients in our large rural state. The COVID-19 pandemic rapidly accelerated our timeline for telehealth implementation and dramatically expanded our telehealth patient volume. The need for telehealth has been sustained over the pandemic with ongoing surges and physical distancing needs in clinic.To maintain high-level patient care and support our team members, we quickly realized that our telehealth program required a multipronged strategy emphasizing 1) clinical logistics, 2) adoption of new assessment tools, 3) patient triage, and 4) needs assessments for and trust-building with internal and external stakeholders.
Description: In the early months of the pandemic, 90-95% of NP/MD patient visits occurred via telehealth. As surgical volume resumed in Summer 2020, telehealth volume reached and then was sustained at 70% of NP/MD patient volume. Shortly before the Summer 2021 surge, we reached 50% inperson NP/MD visits.Modifications include structuring of preoperative assessment interviews to ensure optimal yield of clinical information about patients, especially in the absence of full physical exams. We developed pathways to ensure preop labs and EKGs were completed prior to DOS, though also noted a reduction in low value preoperative or duplicative testing by harnessing EHR interoperability around the Pacific Northwest. We adapted geriatric and frailty screening tools to the virtual/phone format, pivoting from the Edmonton Frail Scale and Mini-Cog to the FRAIL scale and Animal Verbal Fluency Test. We honed patient triage and candidate selection for telehealth visits, including focusing on patient medical characteristics, geography, mobility, access to technology, and psychosocial support. Internal and external stakeholders through this process were also clearly defined and repeatedly engaged, including clinic clinicians adapting to prolonged telecommute mandates and surgeons and anesthesiologists across our institution whose patients we were assessing. We also reimagined our medical assistant workflows to help clinicians continue to work as close to the top of their licenses as possible.
Conclusions: Nearly two years into the pandemic, we continue to have a robust telehealth preop program. We continue to reflect on successes and challenges of patient care in this space, refine the program to meet ongoing needs for remote care, and engage stakeholders to optimize our care pathways.