Pediatric Otolaryngology Telehealth in Response to COVID-19 Pandemic: Lessons Learned and Impact on the Future Management of Pediatric Patients

Background: Since the start of the COVID-19 pandemic outpatient medicine has drastically been altered how it is delivered. This time period likely represents the largest volume of telehealth visits in the United States health care history. Telehealth presents unique challenges within each subspecialty, and pediatric otolaryngology is no different. This retrospective review was designed to evaluate our division of pediatric otolaryngology’s experience with telehealth during the COVID19 pandemic. Methods: This study was approved by the Institutional Review Board at Vanderbilt University Medical Center. All telehealth and face-to-face visits for the month of April 2020 completed by the Pediatric Otolaryngology Division were reviewed. A survey, utilizing both open-ended questions and Likert scaled questions was distributed to the 16 pediatric otolaryngology providers in our group to reflect their experience with telehealth during the 1-month study period. Results: In April, 2020 our outpatient clinic performed a total of 877 clinic visits compared to 2260 clinic visits in April 2019. A total of 769 (88%) were telehealth visits. Telemedicine with video comprised 523 (68%) and telephone only comprised 246 (32%). There were 0 telehealth visits in April 2019. Interpretive services were required in 9.3% (N = 211) clinic visits in April 2019 and 7.5% (N = 66) of clinic visits in April 2020. The survey demonstrated a significant difference ( P < .00002) in provider’s anticipated telehealth experience (mean 3.94, 95% CI [3.0632, 4.8118] compared to their actual experience after the study period (mean 7.5, 95% CI [7.113, 7.887]. Conclusions: Despite low initial expectations for telehealth, the majority of our providers felt after 1 month of use that telehealth would continue to be a valuable platform post-pandemic clinical practice. Limited physical exam, particularly otoscopy, nasal endoscopy, and nasolaryngoscopy present challenges. However, with adequate information and preparation for the parents and for the physician some of the obstacles can be overcome.

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The COVID Army: Experiences from the Deployment of Non-Hospitalist Physician Volunteers during the 2020 COVID Pandemic

Disaster Medicine and Public Health Preparedness ◽

10.1017/dmp.2021.109 ◽

2021 ◽

pp. 1-15

Author(s):

Kevin Hauck ◽

Katherine Hochman ◽

Mark Pochapin ◽

Sondra Zabar ◽

Jeffrey A Wilhite ◽

...

Keyword(s):

New York ◽

New York City ◽

Medical Center ◽

The United States ◽

Lessons Learned ◽

Front Line ◽

Clinical Leadership ◽

Team Members ◽

Medical Centers ◽

Hospitalist Physician

Abstract Objective New York City was the epicenter of the outbreak of the 2020 COVID-19 pandemic in the United States. As a large, quaternary care medical center, NYU Langone Medical Center was one of many New York medical centers that experienced an unprecedented influx of patients during this time. Clinical leadership effectively identified, oriented, and rapidly deployed a “COVID Army”, consisting of non-hospitalist physicians, to meet the needs of this patient influx. We share feedback from our providers on our processes and offer specific recommendations for systems experiencing a similar influx in the current and future pandemics. Methods In order to assess the experiences and perceived readiness of these physicians (n=183), we distributed a 32-item survey between March and June of 2020. Thematic analyses and response rates were examined in order to develop results. Results Responses highlighted varying experiences and attitudes of our front-line physicians during an emerging pandemic. Thematic analyses revealed a series of lessons learned, including the need to: (1) provide orientations, (2) clarify roles/ workflow, (3) balance team workload, (4) keep teams updated on evolving policies, (5) make team members feel valued, and (6) ensure they have necessary tools available. Conclusions Lessons from our deployment and assessment are scalable at other institutions.

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Effect of Tornado Outbreaks on Morbidity and Mortality in Texas

Prehospital and Disaster Medicine ◽

10.1017/s1049023x19001171 ◽

2019 ◽

Vol 34 (s1) ◽

pp. s50-s50

Author(s):

A. Swienton ◽

Daniel Goldberg ◽

Tracy Hammond ◽

Andrew Klein ◽

Jennifer Horney

Keyword(s):

Disaster Preparedness ◽

The United States ◽

Morbidity And Mortality ◽

National Science Foundation Grant ◽

Research Experience ◽

Institutional Review ◽

Gis Tools ◽

Significant Difference ◽

Mortality Improvement ◽

Tornado Outbreaks

Introduction:In the United States, tornadoes are the third leading cause of fatalities from natural disasters1. To aid prevention and mitigation of tornado-related morbidity and mortality, improvement in standardizing tornado specific threat analysis terminology was assessed. The largest number of tornado-related fatalities has occurred in the state of Texas for over a hundred years. The occurrence of tornadic clusters or “outbreaks” has not been formally standardized. The concept of “tornado outbreaks” is better defined and its role in fatality mitigation is addressed in this Institutional Review Board (IRB) approved study.Aim:To understand the role of “tornado outbreaks” related clusters in Texas in relationship to morbidity and mortality.Methods:This IRB approved (IRB2017- 0507) research study utilized GIS tools and statistical analysis of historical data to examine the relationship between tornado severity (based on the Fujita Scale), the number of tornadoes, and the trends in morbidity and mortality. This study was funded in part from The National Science Foundation grant (NSF Grant #1560106) in support of the CyberHealthGIS Research Experience for Undergraduates (REU).Results:A statistically significant difference was demonstrated between the severity of a tornado and related morbidity and mortality during “tornado outbreaks” in Texas during a defined 30-year period.Discussion:Understanding the role and discerning the impacts of “tornado outbreaks” as related to tornado severity has critical implications to disaster preparedness. Applications of this conclusion may improve shelter planning/preparation, timely warning, and educating the at-risk public. Subsequently, examining the likelihood and improved descriptions of “tornado outbreaks” may aid in reducing the number of tornado-related injuries and fatalities nationally.

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Telemedicine in Neurosurgery: Lessons Learned from a Systematic Review of the Literature for the COVID-19 Era and Beyond

Neurosurgery ◽

10.1093/neuros/nyaa306 ◽

2020 ◽

Vol 88 (1) ◽

pp. E1-E12 ◽

Cited By ~ 1

Author(s):

Daniel G Eichberg ◽

Gregory W Basil ◽

Long Di ◽

Ashish H Shah ◽

Evan M Luther ◽

...

Keyword(s):

Systematic Review ◽

The United States ◽

Lessons Learned ◽

Patient Encounter ◽

Review Of The Literature ◽

Face To Face ◽

Regulatory Changes ◽

Foreign Countries ◽

Neurosurgical Patients ◽

Barriers And Challenges

Abstract BACKGROUND Evolving requirements for patient and physician safety and rapid regulatory changes have stimulated interest in neurosurgical telemedicine in the COVID-19 era. OBJECTIVE To conduct a systematic literature review investigating treatment of neurosurgical patients via telemedicine, and to evaluate barriers and challenges. Additionally, we review recent regulatory changes that affect telemedicine in neurosurgery, and our institution's initial experience. METHODS A systematic review was performed including all studies investigating success regarding treatment of neurosurgical patients via telemedicine. We reviewed our department's outpatient clinic billing records after telemedicine was implemented from 3/23/2020 to 4/6/2020 and reviewed modifier 95 inclusion to determine the number of face-to-face and telemedicine visits, as well as breakdown of weekly telemedicine clinic visits by subspecialty. RESULTS A total of 52 studies (25 prospective and 27 retrospective) with 45 801 patients were analyzed. A total of 13 studies were conducted in the United States and 39 in foreign countries. Patient management was successful via telemedicine in 99.6% of cases. Telemedicine visits failed in 162 cases, 81.5% of which were due to technology failure, and 18.5% of which were due to patients requiring further face-to-face evaluation or treatment. A total of 16 studies compared telemedicine encounters to alternative patient encounter mediums; telemedicine was equivalent or superior in 15 studies. From 3/23/2020 to 4/6/2020, our department had 122 telemedicine visits (65.9%) and 63 face-to-face visits (34.1%). About 94.3% of telemedicine visits were billed using face-to-face procedural codes. CONCLUSION Neurosurgical telemedicine encounters appear promising in resource-scarce times, such as during global pandemics.

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The Tennessee Men’s Health Report Card: A Model for Men’s Health Policy Advocacy and Education

American Journal of Men s Health ◽

10.1177/1557988319882586 ◽

2019 ◽

Vol 13 (5) ◽

pp. 155798831988258 ◽

Cited By ~ 1

Author(s):

Derek M. Griffith ◽

Andrea R. Semlow ◽

Mike Leventhal ◽

Clare Sullivan

Keyword(s):

Medical Center ◽

Well Being ◽

The United States ◽

Men’S Health ◽

Report Card ◽

The State ◽

Lessons Learned ◽

Men's Health ◽

Health Report ◽

Vanderbilt University

Tennessee is the only state in the United States that has regularly published a document monitoring men’s health and assessing men’s health disparities. Vanderbilt University, Vanderbilt University Medical Center, the Tennessee Department of Health, Meharry Medical College, Tennessee Men’s Health Network, and health providers and advocates across the state have come together to publish a set of indicators as the Tennessee Men’s Health Report Card (TMHRC). This article describes the origins, structure, development, and lessons learned from publishing report cards in 2010, 2012, 2014, and 2017. The report card highlights statistically significant changes in trends over time, identifies racial, ethnic, age, and geographic differences among men, highlights connections to regional and statewide public health initiatives, and suggests priorities for improving men’s health in Tennessee. State data were compared to Healthy People 2020 Objectives and graded based on the degree of discrepancy between the goal and the current reality for Tennessee men. Over the four iterations of the report card, the TMHRC team has made significant adjustments to the ways they analyze and present the data, utilize grades and graphics, consider the implications of the data for the economic well-being of the state, and disseminate the findings across the state to different stakeholders. It is important to go beyond creating a summary of information; rather, data should be shared in ways that are easily understood, actionable, and applicable to different audiences. It is also critical to highlight promising policy and programmatic initiatives to improve men’s health in the state.

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Shed-MEDS: pilot of a patient-centered deprescribing framework reduces medications in hospitalized older adults being transferred to inpatient postacute care

Therapeutic Advances in Drug Safety ◽

10.1177/2042098618781524 ◽

2018 ◽

Vol 9 (9) ◽

pp. 523-533 ◽

Cited By ~ 9

Author(s):

Alec W. Petersen ◽

Avantika S. Shah ◽

Sandra F. Simmons ◽

Matthew S. Shotwell ◽

J. Mary Lou Jacobsen ◽

...

Keyword(s):

Older Adults ◽

Usual Care ◽

Medical Center ◽

Academic Medical Center ◽

The United States ◽

Patient Centered ◽

Convenience Sample ◽

Point Reduction ◽

Significant Difference ◽

Hospitalized Older Adults

Background: Polypharmacy is common in hospitalized older adults. Deprescribing interventions are not well described in the acute-care setting. The objective of this study was to describe a hospital-based, patient-centered deprescribing protocol (Shed-MEDS) and report pilot results. Methods: This was a pilot study set in one academic medical center in the United States. Participants consisted of a convenience sample of 40 Medicare-eligible, hospitalized patients with at least five prescribed medications. A deprescribing protocol (Shed-MEDS) was implemented among 20 intervention and 20 usual care control patients during their hospital stay. The primary outcome was the total number of medications deprescribed from hospital enrollment. Deprescribed was defined as medication termination or dose reduction. Enrollment medications reflected all prehospital medications and active in-hospital medications. Baseline characteristics and outcomes were compared between the intervention and usual care groups using simple logistic or linear regression for categorical and continuous measures, respectively. Results: There was no significant difference between groups in mean age, sex or Charlson comorbidity index. The intervention and control groups had a comparable number of medications at enrollment, 25.2 (±6.3) and 23.4 (±3.8), respectively. The number of prehospital medications in each group was 13.3 (±4.6) and 15.3 (±4.6), respectively. The Shed-MEDS protocol compared with usual care significantly increased the mean number of deprescribed medications at hospital discharge and reduced the total medication burden by 11.6 versus 9.1 ( p = 0.032) medications. The deprescribing intervention was associated with a difference of 4.6 [95% confidence interval (CI) 2.5–6.7, p < 0.001] in deprescribed medications and a 0.5 point reduction (95% CI −0.01 to 1.1) in the drug burden index. Conclusions: A hospital-based, patient-centered deprescribing intervention is feasible and may reduce the medication burden in older adults.

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Running With Your Hair on Fire: Lessons Learned From Transitioning a National University Sales Competition From Face-to-Face to Virtual in 16 Days

Journal of Marketing Education ◽

10.1177/0273475320950015 ◽

2020 ◽

Vol 42 (3) ◽

pp. 257-271

Author(s):

Scott Inks ◽

Kenyatta Barber ◽

Terry W. Loe ◽

Lukas P. Forbes

Keyword(s):

United States ◽

The United States ◽

Educational Environment ◽

Lessons Learned ◽

Future Research ◽

Face To Face ◽

The Past ◽

National University ◽

Virtual Sales

Since their inception, university sales competitions have been key learning and educational components of university sales education. Over the past two decades, the oldest and one of the largest sales competitions in the United States has been held in a face-to-face format. However, due to the educational environment created from the COVID-19 pandemic, this competition was forced to convert to a virtual format over a 16-day period. This research outlines the steps taken to convert this event to virtual format and presents insights for other universities endeavoring to produce virtual sales competition events. Finally, research implications and direction for future research are presented.

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The Effects of Medication Alerts on Prescriber Response in a Pediatric Hospital

Applied Clinical Informatics ◽

10.4338/aci-2016-10-ra-0168 ◽

2017 ◽

Vol 08 (02) ◽

pp. 491-501 ◽

Cited By ~ 5

Author(s):

Judith Dexheimer ◽

Eric Kirkendall ◽

Michal Kouril ◽

Philip Hagedorn ◽

Thomas Minich ◽

...

Keyword(s):

Medical Center ◽

Academic Medical Center ◽

Clinical Decision ◽

The United States ◽

Primary Outcome Measure ◽

Time Of Day ◽

Pediatric Hospital ◽

Institutional Review ◽

Electronic Alerts ◽

Ideal Number

Summary Objective: More than 70% of hospitals in the United States have electronic health records (EHRs). Clinical decision support (CDS) presents clinicians with electronic alerts during the course of patient care; however, alert fatigue can influence a provider’s response to any EHR alert. The primary goal was to evaluate the effects of alert burden on user response to the alerts. Methods: We performed a retrospective study of medication alerts over a 24-month period (1/2013–12/2014) in a large pediatric academic medical center. The institutional review board approved this study. The primary outcome measure was alert salience, a measure of whether or not the prescriber took any corrective action on the order that generated an alert. We estimated the ideal number of alerts to maximize salience. Salience rates were examined for providers at each training level, by day of week, and time of day through logistic regressions. Results: While salience never exceeded 38%, 49 alerts/day were associated with maximal salience in our dataset. The time of day an order was placed was associated with alert salience (maximal salience 2am). The day of the week was also associated with alert salience (maximal salience on Wednesday). Provider role did not have an impact on salience. Conclusion: Alert burden plays a role in influencing provider response to medication alerts. An increased number of alerts a provider saw during a one-day period did not directly lead to decreased response to alerts. Given the multiple factors influencing the response to alerts, efforts focused solely on burden are not likely to be effective. Citation: Dexheimer JW, Kirkendall ES, Kouril M, Hagedorn PA, Minich T, Duan LL, Mahdi M, Szczesniak R, Spooner SA. The effects of medication alerts on prescriber response in a pediatric hospital. Appl Clin Inform 2017; 8: 491–501 https://doi.org/10.4338/ACI-2016-10-RA-0168

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Renin-angiotensin system blockers and susceptibility to COVID-19: a multinational open science cohort study

10.1101/2020.06.11.20125849 ◽

2020 ◽

Cited By ~ 4

Author(s):

Daniel R. Morales ◽

Mitchell M. Conover ◽

Seng Chan You ◽

Nicole Pratt ◽

Kristin Kostka ◽

...

Keyword(s):

Cohort Study ◽

Relative Risk ◽

Large Scale ◽

Medical Center ◽

Angiotensin Receptor Blockers ◽

The United States ◽

Negative Control ◽

Converting Enzyme Inhibitors ◽

Increased Risk ◽

Significant Difference

AbstractIntroductionAngiotensin converting enzyme inhibitors (ACEs) and angiotensin receptor blockers (ARBs) could influence infection risk of coronavirus disease (COVID-19). Observational studies to date lack pre-specification, transparency, rigorous ascertainment adjustment and international generalizability, with contradictory results.MethodsUsing electronic health records from Spain (SIDIAP) and the United States (Columbia University Irving Medical Center and Department of Veterans Affairs), we conducted a systematic cohort study with prevalent ACE, ARB, calcium channel blocker (CCB) and thiazide diuretic (THZ) users to determine relative risk of COVID-19 diagnosis and related hospitalization outcomes. The study addressed confounding through large-scale propensity score adjustment and negative control experiments.ResultsFollowing over 1.1 million antihypertensive users identified between November 2019 and January 2020, we observed no significant difference in relative COVID-19 diagnosis risk comparing ACE/ARB vs CCB/THZ monotherapy (hazard ratio: 0.98; 95% CI 0.84 - 1.14), nor any difference for mono/combination use (1.01; 0.90 - 1.15). ACE alone and ARB alone similarly showed no relative risk difference when compared to CCB/THZ monotherapy or mono/combination use. Directly comparing ACE vs. ARB demonstrated a moderately lower risk with ACE, non-significant for monotherapy (0.85; 0.69 - 1.05) and marginally significant for mono/combination users (0.88; 0.79 - 0.99). We observed, however, no significant difference between drug-classes for COVID-19 hospitalization or pneumonia risk across all comparisons.ConclusionThere is no clinically significant increased risk of COVID-19 diagnosis or hospitalization with ACE or ARB use. Users should not discontinue or change their treatment to avoid COVID-19.

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Forecasting the COVID-19 Pandemic: Lessons learned and future directions

10.1101/2021.11.06.21266007 ◽

2021 ◽

Author(s):

Saketh Sundar ◽

Patrick Schwab ◽

Jade Z.H. Tan ◽

Santiago Romero-Brufau ◽

Leo Anthony Celi ◽

...

Keyword(s):

Healthcare Resource ◽

Public Awareness ◽

The United States ◽

Lessons Learned ◽

Health Policies ◽

Mechanistic Models ◽

Future Directions ◽

Public Health Policies ◽

Time Period ◽

Control And Prevention

The Coronavirus Disease 2019 (COVID-19) has demonstrated that accurate forecasts of infection and mortality rates are essential for informing healthcare resource allocation, designing countermeasures, implementing public health policies, and increasing public awareness. However, there exists a multitude of modeling methodologies, and their relative performances in accurately forecasting pandemic dynamics are not currently comprehensively understood. In this paper, we introduce the non-mechanistic MIT-LCP forecasting model, and assess and compare its performance to various mechanistic and non-mechanistic models that have been proposed for forecasting COVID-19 dynamics. We performed a comprehensive experimental evaluation which covered the time period of November 2020 to April 2021, in order to determine the relative performances of MIT-LCP and seven other forecasting models from the United States Centers for Disease Control and Prevention (CDC) Forecast Hub. Our results show that there exist forecasting scenarios well-suited to both mechanistic and non-mechanistic models, with mechanistic models being particularly performant for forecasts that are further in the future when recent data may not be as informative, and non-mechanistic models being more effective with shorter prediction horizons when recent representative data is available. Improving our understanding of which forecasting approaches are more reliable, and in which forecasting scenarios, can assist effective pandemic preparation and management.

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Impact of the COVID19 Pandemic on Admissions and Emergency Department Visits of Adults with Sickle Cell Disease

Blood ◽

10.1182/blood-2020-142803 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 37-38

Author(s):

Alice J. Cohen

Keyword(s):

Emergency Department ◽

Sickle Cell Disease ◽

Sickle Cell ◽

Medical Center ◽

Cell Disease ◽

Face To Face ◽

Outpatient Visits ◽

Pain Medications ◽

Time Period ◽

Ed Visits

Background: The most common complication of sickle cell disease (SCD) in adults is vaso-occlusive crisis that is characterized by severe pain. These events can often be managed at home with oral analgesics, but if the pain is not controlled or the patient develops other associated problems, they seek care in an emergency department (ED). In the ED, they receive initial treatment with pain medications and are assessed for other complications such as infection and acute chest syndrome. If an individual's pain is not controlled in a short period of time, the majority of these patients are admitted to the hospital for inpatient management or placed in an observation unit (OBs) for 6-47 hours. The COVID-19 pandemic affected the Greater Newark community starting in mid March with the majority of all inpatient admissions (Ads) being COVID related through the end of May. It has been observed both at our medical center and nationally that during this time period and even afterwards, the number of ED visits and Ads had significantly fallen. The reasons for this finding may include fear of contracting COVID infection at the hospital, regular telemedicine (TM) calls to facilitate outpatient management, and an increase in the number of prescriptions of home pain medications. The purpose of this analysis was to examine patterns of ED visits, Ads, outpatient visits, prescription renewals and nurse (RN) and social worker (MSW) calls in order to determine the impact of COVID-19 infection on the local SCD community. Methodology: A retrospective review was undertaken of billing data and the EMR of all patients with SCD treated at Newark Beth Israel Medical Center (a 450 bed community-based academic tertiary care medical center) between January 2020 and June 2020. Data collected included the number of and reason for ED and OBs, Ads, the number of TM and outpatient visits, and MSW and RN telephone contacts. All patients 18 years of age and older were included. Overall, 100 adults with SCD received care between January and June. Results: Peak hospital COVID Ads, ED and OBs for all patients (SCD and non-SCD) occurred during the weeks between March 25 and May 24, 2020 with a daily inpatient census over 200 between April 7 and 24. SCD Ads at peak COVID (April-May) were significantly lower at 26±2/month compared to 64±11/month pre-COVID (January-February) (p= 0.04). ED and OBs were unchanged. During the peak of COVID, 10/93 (11%) SCD Ads (1 death) were COVID related with 80/96 (86%) for uncomplicated pain crises. MSW and RN called all patients proactively to offer support at onset of COVID pandemic. During this same time period, the number of MSW telephone contacts increased from 138±37/month pre-COVID to 372±21/month during COVID (p=0.02). RN contacts with SCD patients were stable and mostly were for pain prescription renewals. TM was initiated in March 2020 and an increase in these visits correlated with a fall in face to face physician visits: 83.5±11/month pre-COVID to 39.5±8/month peak COVID (p= 0.04), and TM 0/month pre-COVID and 31±4/month peak COVID (0.01). Conclusion: The outbreak of COVID-19 in the community reduced the number of Ads for patients with SCD without an increase in ED and OBs visits. MD face-to-face encounters were reduced but outpatient care continued with the initiation of TM, regular RN contact with maintenance of pain medication prescriptions and a greater numbers of MSW calls for psychosocial support. Further investigation and understanding of the use of Ads for SCD care, and the reduction during COVID, may have implications for current SCD management. Disclosures Cohen: GBT: Speakers Bureau.

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