Telemedicine for veterans in the setting of the COVID-19 pandemic: Lessons learned from a virtual urgent care center

2021 ◽  
pp. 1357633X2110690
Author(s):  
Veronica Sikka ◽  
Christian King ◽  
Suzanne Klinker ◽  
Theresa Mont ◽  
Bonnie Sommers-Olson ◽  
...  
Keyword(s):  
Care Center ◽  
Virgin Islands ◽  
Lessons Learned ◽  
Urgent Care ◽  
Care Organization ◽  
Healthcare Outcomes ◽  
Contact Center ◽  
Public Places ◽  
Urgent Care Center ◽  
At Home

Introduction Although telemedicine was predominantly adopted during the COVID-19 pandemic, its impact on healthcare outcomes in the veteran population in achieving first contact resolution, or the ability to safely manage patient care at home from an urgent care perspective, is yet to be determined. Methods This study included 13,090 veteran patient episodes who presented to the Department of Veteran's Affairs Veterans Integrated Services Network 8's Clinical Contact Center, a virtual urgent care organization covering South Georgia, Florida, and U.S. Virgin Islands in providing episodic care, between March 2020 and February 2021. Multivariate logistic regression estimated the probability that veterans with COVID-19-related symptoms stayed at home compared to presenting to the emergency department (ED) or their primary care provider. Results Patients with COVID-related symptoms were 33% less likely to present to the ED compared to patients who presented with non-COVID-related symptoms. Discussion The virtual urgent care center enabled veterans to receive timely care and avoid public places that could potentially lead to a COVID-19 infection or infecting others.

TeleTriage at a high-volume specialty cancer center: Aligning patient volume and need with available resource.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 2085-2085
Author(s):  
Stutman E Robin ◽  
Jason Napoli ◽  
Erika Duggan ◽  
Danny Joseph ◽  
Eoin Dawson ◽  
...  
Keyword(s):  
Care Center ◽  
Standard Of Care ◽  
High Volume ◽  
Urgent Care ◽  
Cancer Center ◽  
Patient Volume ◽  
Complete Evaluation ◽  
Urgent Care Center ◽  
Patients Experience ◽  
At Home

2085 Background: The Memorial Sloan Kettering (MSK) Urgent Care Center (UCC) functions as the emergency room for MSK. With 23,000+ visits annually, increasing volume and acuity means more days over capacity. Patients experience increased wait times to see clinicians, complete evaluation, and transfer to an inpatient bed. The UCC TeleTriage Program is a remote triage program which aims to align patient volume and need with available resources, improve patient experience, and streamline flow through the UCC. By managing resources more efficiently and expediting initial evaluation, the program promotes timely patient access to care, while maintaining MSK's standard of care. Methods: UCC TeleTriage began July 2018 with the Gastrointestinal Medical Oncology service. The Service Nurse refers patients to TeleTriage on weekdays, from 9a.m.- 4:30p.m. The TeleTriage clinician contacts each patient within 30 minutes of referral, takes the history, and determines the initial plan. Patients are directed to a local ER, clinic, or UCC based on level of acuity, real-time GPS, and specific need. For stable patients coming to UCC, TeleTriage focuses on initiating testing prior to registration in UCC. Results: TeleTriage patients have (virtual) contact with a UCC clinician within 30 minutes of referral, whereas non-TeleTriage patients wait 110 minutes or more. TeleTriage patients are discharged from UCC up to 42 minutes more rapidly. TeleTriage patients who receive imaging prior to registration in UCC receive a final disposition up to 93 minutes sooner. About 4% of TeleTriage patients are managed at home. In a small number of TeleTriage patients with severe complications of cancer-treatment, significant morbidity was avoided due to early intervention and coordination of care. Conclusions: TeleTriage patients have contact with a UCC clinician measurably faster than non-TeleTriage patients. Their evaluation is also started earlier. By managing less acute patients at remote sites or at home, TeleTriage can help patients avoid unnecessary travel, (time) expenditure, and hospital contact. TeleTriage patients who come to UCC, spend less time in UCC than non-TeleTriage patients and they discharge faster. By utilizing cancer care expertise, TeleTriage can significantly impact patient outcomes and utilize resources more effectively.

scholarly journals Increase in Urgent Care Center Visits for Sexually Transmitted Infections, United States, 2010–2014

2017 ◽  
Vol 23 (2) ◽  
pp. 367-369 ◽  
Author(s):  
William S. Pearson ◽  
Guoyu Tao ◽  
Karen Kroeger ◽  
Thomas A. Peterman
Keyword(s):  
United States ◽  
Sexually Transmitted Infections ◽  
Care Center ◽  
Urgent Care ◽  
Urgent Care Center ◽  
Sexually Transmitted

Capacity Rationing in Primary Care: Provider Availability Shocks and Channel Diversion

2021 ◽  
Author(s):  
Hessam Bavafa ◽  
Anne Canamucio ◽  
Steven C. Marcus ◽  
Christian Terwiesch ◽  
Rachel M. Werner
Keyword(s):  
Operations Management ◽  
Care Center ◽  
Urgent Care ◽  
Veterans Health ◽  
Health Administration ◽  
Urgent Care Center ◽  
Standard Deviations ◽  
Using Data ◽  
Capacity Constrained

We study capacity rationing by servers facing differentiated customer classes using data from the Veterans Health Administration, which is the largest integrated healthcare system in the U.S. Using more than 11 million health encounters over two years in which the system was capacity constrained, our study provides a comprehensive analysis of the impacts of provider availability shocks on care channel diversion and delays. The outcomes studied include emergency room (ER) visits broken down by type, urgent care center visits, office and phone visits with one’s own versus another provider, post-ER follow-up visits, and ER readmissions. Availability shocks in our analysis are a residualized measure characterizing weeks in which the provider has fewer (or more) office appointments than expected based on typical patterns. The main finding is that moving from two standard deviations above to two standard deviations below in availability shocks increases ER visits by 2.4%, or about 20,000 yearly ER visits. Interestingly, the increase in ER visits is only present for the non-emergent category, indicating differentiated service to emergent and non-emergent care requests; capacity-constrained providers still tend to the patients in most need. Another finding is that provider availability shocks delay and divert post-ER follow-up care. Yet there is no effect on ER readmissions, a severe outcome of delayed or foregone follow-up, indicating that providers ration by priority these follow-up appointments. This paper was accepted by Vishal Gaur, operations management.

scholarly journals Comparison of Quidel Sofia SARS FIA Test to Hologic Aptima SARS-CoV-2 TMA Test for Diagnosis of COVID-19 in Symptomatic Outpatients

2020 ◽  
Author(s):  
Eric T. Beck ◽  
Wendy Paar ◽  
Lara Fojut ◽  
Jordan Serwe ◽  
Renee R. Jahnke
Keyword(s):  
Symptom Onset ◽  
Care Center ◽  
Urgent Care ◽  
Molecular Diagnostic ◽  
Nasopharyngeal Swab ◽  
Urgent Care Center ◽  
Ct Value ◽  
High Prevalence ◽  
Nasal Swabs ◽  
Molecular Diagnostic Test

The Quidel Sofia SARS FIA test (SOFIA) is a rapid antigen immunoassay for detection of SARS-CoV-2 viral proteins from nasal or nasopharyngeal swab specimens. The purpose of this study was to compare the results of the SOFIA test to the Hologic Aptima SARS-CoV-2 TMA test (APTIMA TMA), a high-throughput molecular diagnostic test that uses transcription mediated amplification for detection of SARS-CoV-2 nucleic acid from upper respiratory specimens. Three hundred and 40-seven symptomatic patients, from an urgent care center in an area with a high prevalence of SARS-CoV-2 infections, were tested in parallel using nasal swabs on the SOFIA test and nasopharyngeal swabs on the APTIMA TMA test. The SOFIA test demonstrated an 82.0% positive percent agreement (PPA) compared to the APTIMA TMA test for symptomatic patients tested ≤ 5 days from symptom onset and a 54.5% PPA for symptomatic patients > 5 days from symptom onset. The Cepheid Xpert Xpress SARS-CoV-2 RT-PCR test was used to determine the cycle threshold (Ct) value from any specimens that were discrepant between the SOFIA and APTIMA TMA tests. Using a Ct value of ≤ 35 as a surrogate for SARS-CoV-2 culture positivity, we estimate that the SOFIA test detected 87.2% of symptomatic patients tested ≤ 5 days from symptom onset that were likely to be culture positive.

scholarly journals 2060. Evaluation of a Pharmacist’s Impact on Antimicrobial Prescribing in an Urgent Care Center

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S694-S694
Author(s):  
Amy Fabian ◽  
Sara Linnertz ◽  
Lisa Avery
Keyword(s):  
Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Viral Infections ◽  
Care Center ◽  
Urgent Care ◽  
Antibiotic Prescribing ◽  
Composite Outcome ◽  
Post Intervention ◽  
Urgent Care Center ◽  
Tract Infections

Abstract Background The urgent care center (UC) setting is an opportunity for pharmacists to promote antimicrobial stewardship (AS). The primary objective is to determine compliance with antibiotic prescribing recommendations for the treatment of urinary tract infections (UTIs), skin and soft-tissue infections (SSTIs), upper respiratory tract infections (URIs), and lower respiratory tract infections (LRTIs) before, during, and after the presence of an AS pharmacist in an UC. Methods Single-center, retrospective, observational, pre (December 10, 2018–January 6, 2019), intervention (January 7–February 3, 2019), and post-intervention (February 4–March 3, 2019) study. All non-pregnant, adult patients with a chief complaint consistent with UTI, SSTI, URI, or LRTI were included. Patients transferred to another facility, presented for a follow-up visit, with multiple sites of infection, or treated for a bite, wound, or surgical site infection were excluded. Noncompliance (NC) was a composite endpoint of non-guideline adherent antibiotic prescribing for viral infections, inappropriate empiric selection, duration, and/or dosage. Secondary outcomes include composite outcome components and subgroup analysis of disease states. Results A total of 1,930 patients were screened with 439,440, and 430 patients included in the pre, intervention, and post-intervention group. Demographics were similar between groups, except for age (P = 0.001) and influenza diagnoses (P < 0.001). NC decreased from 43.3% to 31.1% (P = 0.0002) pre-intervention to intervention and from 31.1% to 26.5% (P = 0.14) post-intervention. Pre-intervention to intervention resulted in a change in composite outcome components of non-compliant prescribing (18.9% to 13%, P = 0.02), empiric selection (8.7% to 5.9%, P = 0.12), duration (4.1% to 5.9%, P = 0.28), dosage (3.4% to 0.5%, P = 0.001), and multiple components for NC (8.2% to 6.4%, P = 0.3). Reductions in NC were seen for UTI (83.3% to 69.2%, P = 0.26), SSTI (45.7% to 42.9%, P = 1.0), URI (23.5% to 23.2%, P = 1.0), and LRTI (82.1% to 51.6%, P = 0.0004). Conclusion An AS pharmacist’s presence in a UC significantly reduced NC to antibiotic prescribing recommendations. The largest impact was in reducing antibiotic treatment of viral infections and optimizing antibiotic dosing. Disclosures All authors: No reported disclosures.

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