JMIR Publications

ABSTRACT

Background:

Increasing incidence of coronavirus 2019 (COVID-19) infection has challenged healthcare systems to increase capacity while needing to conserve personal protective equipment (PPE) supplies and minimize nosocomial spread. Telemedicine shows promise to address these challenges but lacks comprehensive evaluation in the inpatient environment.

Objective:

To evaluate an intra-hospital telemedicine program (virtual care), along with its impact on exposure risk and communication.

Methods:

We conducted a natural experiment of virtual care on patients admitted for COVID-19. The primary exposure variable was documented use of virtual care. Patient characteristics, PPE use rates and their association with virtual care use were assessed. In parallel, we conducted surveys with patients and clinicians to capture satisfaction with virtual care along the domains of communication, medical treatment, and exposure risk.

Results:

Of 137 total patients in our primary analysis, 43 patients used virtual care. In total, there were 82 inpatient days of use and 401 inpatient days without use. Hospital utilization and illness severity was similar in patients who opted-in vs opted-out. Virtual care was associated with a significant reduction in PPE use and physical exam rate. Surveys of 41 patients and clinicians showed high rates of recommendation for further use, and subjective improvements in communication. However, providers and patients expressed limitations in usability, medical assessment and empathetic communication.

Conclusions:

In this pilot natural experiment, only a subset of patients used inpatient virtual care. When used, virtual care was associated with reductions in PPE use, reductions in exposure risk, and patient and provider satisfaction.