COVID-19 hit hospitals hard, leaving providers with an influx of new patients and uncertainty about how to move forward. A new commentary in Circulation: Heart Failure offers a first-hand account of how one facility faced the pandemic head-on, embracing telehealth to ensure patients with advanced heart failure (HF) received the high-quality care they deserve.
“At our institution, we balanced the deferred/cancelled face-to-face HF visits with rapid adoption of virtual visits—from zero to 159 in five weeks—while employing several novel virtual health technologies with overall positive results,” wrote co-authors Aws Almufleh, MBBS, MPH, and Michael M. Givertz, MD, of Brigham and Women’s Hospital in Boston.
These are three key recommendations from the duo’s commentary:
1. Determine when urgent care patients need to come in and when they can stay at home
Urgent care patients “with concerning symptoms” were greeted with an automated tool that could determine if they truly needed to be seen in person—or if they could simply see someone virtually. When patients responded to key questions, the tool would help determine the next necessary step.
“By providing safe virtual options to seek medical treatment, patients are more likely to promptly access the needed care while reducing unnecessary—and at times risky—ED visits,” the authors wrote.
When outpatient in-house appointments were replaced with virtual visits, the authors noted, it was important to consider the needs of “older and less tech-savvy patients.” In those instances, a caregiver or support staff employee was used as necessary to review all patient information and confirm medications before any virtual visit needed to take place.
“Furthermore, virtual visits are enhanced by integrating remote patient monitoring data (including weight and blood pressure),” according to Almufleh and Givertz. “In fact, trended home vital signs may provide a better gauge for guideline-directed medical therapy optimization as opposed to the snapshots obtained during face-to-face encounters which are susceptible to multiple sources of error.”
Point-of-care ultrasound (POCUS) equipment should be available for instances when inpatients present with potential COVID-related cardiac issues. The authors noted that a pilot program was launched that involved training residents on the basics of POCUS, allowing them to perform basic examinations and send the results directly to HF specialists.
“Importantly, because most hospitals have restricted visitor access during COVID-19, the use of in-room video conferencing with patients and family can be instrumental in facilitating critical conversations, including treatment decisions and advanced care planning,” the authors wrote. “Upon discharge, early follow-up can be arranged via telemedicine to ensure safe transition of care, monitor adherence, and uptitrate guideline-directed medical therapy after establishing clinical stability and resolution of congestion.”