U of U Health Departments of Neurology and Neurosurgery Quickly Adopt Virtual Visits in Response to COVID-19 Pandemic
Jul 27, 2020 12:00 AM
When nonessential visits were suspended in mid-March, the Departments of Neurology and Neurosurgery at University of Utah Health were quick to adopt virtual visits.
Providing telemedicine is not new to the Neurosciences, but has not been widely implemented in ambulatory neuro care. TeleStroke, a robust, longstanding program, and the newer, expanded TeleNeurology program connect acutely ill patients in regional hospitals to U of U Health Neurologists in Salt Lake City. However, before the COVID-19 pandemic, neuro patients could not virtually connect from home to their provider for an outpatient visit. The team knew they needed to move swiftly to get more than 100 providers active on virtual visits.
"Our key success factor to rapidly expanding our teleservices has been a strategy that focuses on making real-time, incremental improvements to our processes through a continuous feedback loop," says Dr. Vivek Reddy, MD, MMM, associate vice chair of strategy in the Department of Neurology.
"Our clinical and operational teams work closely together instituting changes based on the feedback and do small tests of change to optimize the process. Providers have been willing to try new workflows and adapt to technology changes rapidly because they know that their feedback is heard, and we use it to focus on improvement.
As a leadership team, we laid out a bold and aggressive expansion strategy, but balanced our approach with a commitment to listen and utilize real-time feedback to adjust our plans based on what worked best for our patients."
On a busy day before the pandemic, 300 outpatient visits would occur across the Neurosciences. Since March 16th, 77% of outpatient visits have been conducted by phone or video, including post-surgical follow-up, ongoing management of chronic conditions like Parkinson's, new back pain evaluation, and much more.
"We had to cancel more than 2,000 visits in March, so we moved as quickly as possible, in a staged approach, to both adopt the technology available to us and to build workflows the staff and providers could rely upon," says Director of Outpatient Services for Neurosciences Danielle Freeman, MHSM.
There are varying opinions about the use of technology to deliver care, but the Neurosciences has shown great promise overcoming barriers and providing specialty care to patients throughout the Mountain West region.
With the addition of virtual visits, technology allows some patients to stay in their community throughout the entire care continuum. For example, a patient presenting with seizures in the emergency room at a regional hospital in Idaho is connected to a U of U Health neurologist for an emergent TeleNeurology consultation. Once the patient is admitted to that hospital, they can receive scheduled TeleNeurology consultations for the duration of their inpatient stay. Now, that same patient also has a follow-up virtual visit with a U of U Health neurologist specializing in seizures.
"We incorporated the need to reach our patients virtually and aligned it with our global strategy to improve access for patients," Reddy says. "This enabled our work to be aligned with our pre-COVID-19 strategy and thus was not seen as a new initiative, just a new way of reaching our goals. This approach also allows these changes to be a part of any of our offerings moving forward. We have built a community of providers that see telehealth as a safe and effective way to care for patients."
Patients have been largely appreciative to see providers from home. Many patients understand how to use the technology or require only minor instruction from the clinic staff.
"We understand virtual care does not work for every patient or in every instance, but it has allowed patients to stay connected to and even establish care with a specialist during this uncertain time," Freeman says. "We've learned so much over the last couple of months and continue to iterate in an effort to optimize processes and meet our patients' needs."
Although there was a huge drop in in-person care in March and April, the Neurosciences are beginning to operate near pre-pandemic capacity. Since we are currently in the "orange phase" of the pandemic, in-person visits are being provided again in conjunction with telehealth. Incredibly, by the end of May, the Neurosciences experienced 97% of their average weekly visit volume over the last six months - this is something nobody would have predicted as the pandemic began to sweep through our community.
Written by Pulse contributor, Shaun Ajay
"It has definitely been a group effort with significant time investments from clinical and operational stakeholders within the service line and also from our partners in departments like Telehealth and IT," Freeman says. "The rate of progress has been remarkable."