Developing a pediatric ophthalmology telemedicine program in the COVID-19 crisis

Abstract

Purpose: To describe our methodology for implementing synchronous telemedicine during the 2019 novel coronavirus (COVID-19) pandemic.

Methods: A retrospective review of outpatient records at a single children's hospital from March 21 to April 10, 2020, was carried out to determine the outcome of already-scheduled face-to-face outpatient appointments. The week leading up to the March 21, all appointments in the study period were categorized as follows: (1) requiring an in-person visit, (2) face-to-face visit that could be postponed, and (3) consultation required but could be virtual. Teams of administrators, schedulers, and ophthalmic technicians used defined scripts and standardized emails to communicate results of categorization to patients. Flowcharts were devised to schedule and implement telemedicine visits. Informational videos were made accessible on social media to prepare patients for the telemedicine experience. Simultaneously our children's hospital launched a pediatric on-demand e-consult service, the data analytics of which could be used to determine how many visits were eye related.

Results: A total of 237 virtual ophthalmology consult visits were offered during the study period: 212 were scheduled, and 206 were completed, of which 43 were with new patients and 163 with returning patients. Following the initial virtual visit, another was required on average in 4 weeks by 21 patients; in-person follow-up was required for 170 patients on average 4.6 months after the initial virtual visit. None needed review within 72 hours. The pediatric on-demand service completed 290 visits, of which 25 had eye complaints.

Conclusions: With proper materials, technology, and staffing, a telemedicine strategy based on three patient categories can be rapidly implemented to provide continued patient care during pandemic conditions. In our study cohort, the scheduled clinic e-visits had a low no-show rate (3%), and 8% of the on-demand virtual access for pediatric care was eye related.

Fig 1

Ophthalmology telemedicine workflow. TMV, telemedicine visit; BC, blind copy.

eFig 1

The dashboard for the on-demand urgent care service attended by emergency room providers. The diagnosis cloud (black arrow) shows different diagnoses of the patients calling in; the diagnoses pertaining to eye problems (gray arrow) is delineated on the righthand side.

eFig 2

Telemedicine guidelines common diseases, outlining the common patient presentations that would require an initial face-to-face assessment (for new patients) and how/when they would be transferred to telemedicine visits and other common scenarios that would be fit for telemedicine either as new patients or for follow-up. AKC, atopic kerato-conjunctivitis; BKC, blepharo-kerato-conjunctivitis; DFE, dilated fundus examination; ED, emergency department; ET, esotropia; I&D, incision and drainage; NLDO, nasolacrimal duct obstruction; PCP, primary care physician; VKC, vernal kerato-conjunctivitis; X(T), intermittent exotropia.