This poster highlighting tele-ID consults was originally presented at IDWeek 2021, held Oct. 19-23 in Washington, D.C.
Aryn Andrzejewski, M.D.1; Rima C. Abdel-Massih, M.D.2,3; John W. Mellors. M.D.2; Nupur Gupta, DO MPH2
1Division of General Internal Medicine, University of Pittsburgh Medical Center; 2Division of Infectious Disease, University of Pittsburgh Medical Center; 3Infectious Disease Connect, Inc.
Contact: guptan8@upmc.edu
Conclusions
- Tele-ID is an effective alternative to in-person ID care at academic medical centers.
- General ID and Transplant ID services were able to evaluate a large proportion of patients with varied ID diagnosis using telemedicine at the onset of the pandemic.
- Amongst the cases, hospital LOS, 30-day mortality and 30-day readmissions were low.
- Compared to matched in-person controls, tele-ID demonstrated significantly lower 30-day readmission and shorter ICU LOS.
Background
- Inpatient tele-ID consults are effective at community hospitals.
- Tele-ID is not utilized at academic medical centers (AMCs) because of the availability of ID physicians in urban settings.
- During the COVID-19 pandemic, tele-ID was implemented at AMCs to minimize exposure and conserve personal protective equipment.
Questions Addressed
- What are the outcomes for patients seen via tele-ID at AMCs?
- Is there a difference in outcomes for patients seen via tele-ID compared to in-person ID care at AMCs?
- Can a tele-ID service make complex diagnoses compared to an in-person service?
Methods
- Longitudinal, matched, case-control study
- Study Sites:
- 3 tertiary AMCs in Pittsburgh, PA
- Over 1,300 beds
- Cases: Tele-ID consults
- March 1, 2020 – May 31, 2020
- Evaluated via video, electronic consults, inpatient phone calls
- Controls: In-person consults
- March 1, 2019 – November 30, 2019
- Evaluated via in-person only prior to the pandemic
- Matched by demographics and ID diagnosis
- Both groups evaluated by existing general ID or transplant ID physicians in the UPMC ID Division
- COVID-19 diagnosis excluded
Characteristic of the Tele-ID Cases (3/1/20 – 5/31/20)
| General ID | Transplant ID | |
|---|---|---|
| Number of consults | 125 | 81 |
| Initial consult location – Floor (#) | 111 | 61 |
| Average age (years; range) | 57.8 (20-92) | 56.8 (24-85) |
| Female (%) | 52 (42%) | 39 (48%) |
| Caucasian (%) | 92 (64%) | 64 (79%) |
| Average Charlson Comorbidity Index (range) | 3.2 (0-13) | 4.4 (0-11) |
| Heart transplant (#) | 9 | |
| Lung transplant (#) | 9 | |
| Kidney transplant (#) | 18 | |
| Stem cell transplant (#) | 4 | |
| CAR-T (#) | 2 | |
| Liver transplant (#) | 12 | |
| Multiple transplants (#) | 7 | |
| Pre-transplant evaluation including LVAD (#) | 18 |
Characteristic of the Tele-ID Cases (3/1/20 – 5/31/20)
| General ID | ||
|---|---|---|
| Average Hospital LOS post-ID consult (days; range) | 6.26 (-0.11 – 39.9) | 6.5 (0.08-33.8) |
| Average ICU LOS (days; range) | 12 (0-27) | 7.6 (0-33) |
| In-hospital mortality (%) | 5 (4%) | 3 (3.7%) |
| 30-day mortality (%) | 3 (2.4%) | 5 (6.2%) |
| 30-day readmission for 1o ID infection (%) | 7 (5%) | 10 (12%) |
Primary Outcomes of Matched In-Person Controls to Tele-ID Cases
| Controls | Cases | Standardized Differences | 95% CI | p-value | |
|---|---|---|---|---|---|
| Number | 633 | 65 | |||
| In-hospital mortality | 7.7% | 4.0% | 0.156 | -12.8 to 1.9% | 0.143 |
| 30-day mortality | 9.8% | 4.9% | 0.187 | -15.6 to 0.9% | 0.080 |
| 60-day mortality | 12.9% | 8.6% | 0.139 | -15.2 to 2.4% | 0.155 |
| 30-day readmission | 17.3% | 5.1% | 0.394 | -25.0 to -4.9% | 0.004 |
| ICU admission | 53.8% | 46.6% | 0.145 | -16.7 to 10.6% | 0.665 |
| ICU LOS (hours) | 269.2 | 118.1 | 0.545 | -365.5 to 81.7% | 0.002 |
Broad Range of ID Diagnosis via Telemedicine
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