Telehealth Coverage for a Pediatric Gastroenterology Consult Service at a Regional Hospital: An Accepted, Useful, and Sustainable Model of Care

Abstract

Objective: To evaluate a novel telehealth inpatient pediatric gastroenterology (GI) consult service at a regional children's hospital in regard to acceptance, utility, quality, sustainability, and provider resiliency.

Study design: Patients requiring GI care at a regional children's hospital between July 2020 and June 2021 were treated by an in-person or telehealth physician with physician assistant support, randomly assigned based on a weekly preset staffing schedule. A retrospective, multidomain program evaluation was performed based on the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) and STEM (SPROUT Telehealth Evaluation and Management) frameworks, using statistical analysis to compare the patient cohorts and anonymous surveys to assess provider perceptions.

Results: In total, 1051 patient-days of GI care were provided for 348 patients, 17% by telehealth and 83% in-person. There were no significant differences in diagnosis, transfer, or readmission rates between the cohorts. No transfers occurred for reasons other than need to access specialized services not available at the regional hospital. Daily consult workload was slightly greater for telehealth physicians. Primary and consult team providers accepted the practice. The model continued beyond the first year. In total, 75% of local GI physicians reported greater Brief Resilience Scores in the context of shifting 20% of their inpatient call weeks to another campus's physicians.

Conclusion: Episodic pediatric GI consult service coverage via telehealth at a regional hospital was well accepted, useful, and sustainable, with improved physician resilience and no adverse outcomes seen. Telehealth holds promise for leveraging pediatric subspecialty physicians across hospitals, allowing complex patients to be admitted closer to home while reducing inpatient coverage requirements for smaller physician groups.

Keywords: gastroenterology; hospital medicine; quality; resiliency; sustainability; telehealth.

Figure 1:. Telehealth Consult Team Rounding Workflow

Note: APP pre-rounding typically consists of chart review, a check-in with the primary service provider managing the patient (e.g. a hospitalist), and a check-in with the patient/ family. Occasionally, the APP will also check-in with the nurse before rounds to clarify chart data or defer check-in with the patient/ family to rounds if time is limited.

Figure 2:. Primary Diagnoses

Figure 3:. Provider Survey Results Regarding Efficacy and Effectiveness of the Telehealth Consult Model

Notes:

1. “Consult Team” respondents were telehealth GI physicians and in-person GI APPs working with the telehealth physicians. “Primary Team” respondents were physicians from the hospital medicine, neonatology and critical care services.

2. There is no bar shown for the Consult Team’s response to the question about phone-only consults being as effective or better than telehealth consults, because 100% of consult team respondents disagreed with this statement.

Figure 4:. Lessons Learned