Telehealth Tag Team: Implementation of a Multidisciplinary Telehealth Visit
Prigi Varghese, CPNP, Tanisha Bailey, RN, Meghana Sathe, MD, Preeti Sharma, MD
Problem: COVID-19 halted the day to day operations at our Cystic Fibrosis center. We were required drastically to decrease in-person clinic visits and stop pulmonary function testing. These measures led to the urgent need for telehealth medicine to support and deliver optimal care for our 300+ patients.
Assessment: The notion of telehealth medicine is new to much of our CF team but not to our institution. Psychology was the only department familiar and active on virtual visits prior to the pandemic. Emergency credentialing and approval for all physicians began first, and then spread to advanced providers. Second tier credentialing of dieticians and physical therapist followed. Social work credentialing was last as not seen as a traditional essential telehealth need. Institutional virtual health department offered training and instruction on how to conduct virtual visits using the AmWell platform. Virtual visits started April 2020. Patients were notified of virtual visits and given instructions either by phone or MyChart on how to prepare for the visit. We joined the CFLN Telehealth Innovation lab in March 2020 to work on integration of multiple disciplines to the virtual visits as standard in clinic. Our aim was to increase percentage of successful multidisciplinary telehealth visits from 0% to 95% by December 2020.
Interventions: Our primary goal was to ensure that virtual patients were seen at least by 2 team members if not more on AmWell. In order to achieve this, we came up with weekly PDSA cycles to trial different groupings of team members on a single call. We also created virtual visit process maps for clinic staff and patients to follow. Telehealth sessions were increased to 60 minutes rather than 30 minutes in order to accommodate the multiple team members. We customized the triage questions on AmWell to our clinic pre visit questions. This enabled providers to visualize at beginning of visit which team members were requested by the family. As the team was remote, we created a telehealth EPIC chat that was utilized by all team members to communicate in real time. The chat helped identify all the team members who needed an invitation to join in on the virtual call and mitigate connection issues. When the patient was in the provider’s waiting room, invitations to all team members were sent via email.
Outcomes: From April 2020- March 2021, we had 297 virtual visits with 225 visits done by 2 team members or more. See Figure 1
While we did not meet the goal of 95%, we were able to sustain this new process at 76%. 43% were seen by 2 team members, 35% by 3, 18% by 4, and less than 5% were seen by 5 or 6 team members. Not every visit required more than one team member. The EPIC telehealth chat in real time was instrumental in team communication.
Conclusion: We are now in sustainability mode with our telehealth process. Our goal continues to be tag teaming to offer the standard multidisciplinary experience for our patients virtually. We will continue to offer virtual visits despite seeing a steep decline since February 2021. We believe that virtual visits will continue to be an important part of care in the future. Next steps involve surveying patients regarding their satisfaction with virtual visit experiences in hopes to continue to improve this platform of care.
