A multidisciplinary telemedicine model for management of COVID-19 in obstetric patients

REFORMA, Liberty G.; DUFFY, Cassandra; COLLIER, Ai-ris Y.; WYLIE, Blair J.; SHAINKER, Scott A.; GOLEN, Toni H.; HERLIHY, Mary; LYDEARD, Aisling; ZERA, Chloe A.

ABSTRACT Background The COVID-19 pandemic caused by the SARS-CoV-2 virus has increased the demand for inpatient healthcare resources; however, approximately 80% of patients with COVID-19 have a mild clinical presentation and can be managed at home. Objective To describe the feasibility, clinical and process outcomes associated with a multidisciplinary telemedicine surveillance model to triage and manage obstetric patients with known exposures and/or symptoms concerning for COVID-19. Study Design We implemented a multidisciplinary telemedicine surveillance model with obstetric physicians and nurses to standardize ambulatory care for obstetric patients with confirmed or suspected COVID-19 based on symptoms or exposures at an urban academic tertiary care center with multiple hospital and community-based affiliated practices. All pregnant or postpartum patients with COVID-19 symptoms, exposures or hospitalization were eligible for inclusion in the program. Patients were assessed via regular nursing phone calls and were managed according to illness severity. Patient characteristics, clinical and process outcomes were abstracted from the electronic medical record. Results A total of 135 patients were enrolled in the multidisciplinary telemedicine model from March 17-April 19, 2020, of whom 130 were pregnant and 5 recently postpartum. The majority (N=116, 86%) were managed solely in the outpatient setting and did not require in-person evaluation; 9 were ultimately admitted after ambulatory or urgent evaluation and 10 patients were followed after hospital discharge. Although only 50% of the patients were tested secondary to limitations in ambulatory testing, 1 in 3 of those was PCR-positive for SARS-CoV-2 (N=22, 16% of entire cohort). Patients were enrolled in the telemedicine model for a median of 7 days (IQR 4-8) and averaged one phone call daily, resulting in 891 nursing calls and 20 physician calls over 1 month. Conclusion A multidisciplinary telemedicine surveillance model for outpatient management of obstetric patients with COVID-19 symptoms and/or exposures is feasible and resulted in rates of ambulatory management similar to those seen in non-pregnant patients. A centralized model for telemedicine surveillance of obstetric patients with COVID-19 symptoms may preserve inpatient resources and prevent avoidable staff and patient exposures, particularly in centers with multiple ambulatory practice settings.