This poster highlighting remote tele-ID consults was originally presented at IDWeek 2021, held virtually Sept. 29 – Oct. 3, 2021
Sui Kwong Li, M.D.1,2; Carolyn Fernandes. M.D.1,2; Sowmya Nanjappa, M.D.1,2; Sarah Burgdorf, M.D.1,2;
Vidya Jagadeesan, M.D.1,2; Bettina Knoll, M.D.1,2, Shanza Khan, M.D.1,2, Nupur Gupta, DO MPH1,2; John W. Mellors. M.D.1,2; Rima Abdel-Massih, M.D.1,2
1. Division of Infectious Diseases, UPMC 2. Infectious Disease Connect
Conclusions
- Mortality rates following e-consults appear to be comparable to those previously reported for in-person infectious disease (ID) care1,2.
- In the absence of in-person ID physicians, ID e-consults may be a reasonable substitute.
- Further study is required to compare performance of ID e-consults to in-person ID consults.
Objective
- Determine whether ID e-consults can be an effective substitute for in-person care
- Establish baseline data for outcomes related to ID e-consults
Background
- Telemedicine (TM) can provide specialty ID care for remote and underserved areas.
- However, the need for dedicated audio-visual equipment, secure and stable internet connectivity, and local staff to assist with the consultation has limited wider implementation of synchronous TM.
- ID e-consults (electronic consultations or asynchronous TM) are an alternative, but data are limited on their effectiveness, especially patient outcomes.
Methods
- In the setting of the COVID-19 pandemic and lack of in-person ID physician coverage, we performed ID e-consults at a 380-bed tertiary care hospital in Blair County, PA.
- We performed retrospective chart reviews of 121 patients initially evaluated by ID e-consults between April 2020 and July 2020.
- Follow-up visits were also conducted via e-consults with or without direct phone calls with the patient.
- Key patient outcomes assessed were length of stay (LOS), disposition, 30-day mortality from initial ID e-consult and 30-day readmission post-discharge.
Key Findings
- Average total LOS post-initial ID e-consult was 7 days and the majority of patients (85%) were discharged to home or a skilled nursing facility.
- Rates of hospital transfer following ID e-consults and readmission within 30 days related to initial infection were low.
Results
| Table 1. Clinical Characteristics (n=121) | |
|---|---|
| Age, mean (SD), y | 61.2 (16.7) |
| Gender, No.% | |
| Female | 50 (41.3) |
| Male | 71 (58.7) |
| Race, No. (%) | |
| White | 115 (95.0) |
| Other | 6 (5.0) |
| BMI, mean (SD) | 31.5 (8.6) |
| Immunocompromised State, No. (%) | 21 (17.4) |
| Immunosuppressive Agents* | 5 (4.1) |
| Solid Tumor | 11 (9.1) |
| Hematologic Malignancy | 5 (4.1) |
| Charlson Comorbidity Index Sore, mean (SD) | 4.8 (3.0) |
| Hospitalization during previous 6 months, No. (%) | |
| Yes | 57 (47.1) |
| No | 64 (52.9) |
| ICU status at the time of e-consult, No. (%) | |
| Yes | 13 (10.7) |
| No | 108 (89.3) |
| Table 2. Outcomes | |
|---|---|
| Length of stay, mean (SD), d | |
| Total | 11 (9) |
| Post initial ID e-consult | 7 (8) |
| Disposition, No. (%) | |
| Home | 59 (48.7) |
| Post-acute rehabilitation facility | 45 (37.2) |
| Left against medical advice | 7 (5.8) |
| Hospice | 3 (2.5) |
| Hospital transfer | 3 (2.5) |
| Index stay mortality | 4 (3.3) |
| Death within 30 d of ID e-consult, No. (%) | 5 (4.1) |
| Readmission within 30 d post-discharge, No. (%) | 31 (25.6) |
| Readmission within 30 d related to initial infection, No. | 17 (14.0) |
References
1Tande AJ, Berbari EF, Ramar P. et al. Association of a Remotely Offered Infectious Diseases eConsult Service with Improved Clinical Outcomes. Open Forum Infectious Diseases. 2020;7(1), ofaa003 https://doi.org/10.1093/ofid/ofaa003
2Schmitt S, McQuillen DP, Nahass R et al. Infectious Diseases Specialty Intervention is Associated with Decreased Mortality and Lower Healthcare Costs. Clin Infect Dis. 2014;58(1):22-8.
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