Posted: May 29, 2020

COVID-19 Remote Patient Monitoring

Description

In the Spring of 2020, a surge in COVID-19 illness overwhelmed the health care system in New York City and necessitated the rapid application of telemedicine in various medical settings. Columbia University’s COVID-19 Student Service Corps (CSSC) has implemented telemedicine efforts in order to provide patient care while maintaining social distancing, to decrease readmission rates, and to reduce further viral spread. The Remote Patient Monitoring (RPM) branch contributes to these efforts by creating a follow-up system for COVID-positive patients discharged to home from New York-Presbyterian’s emergency department, Milstein Hospital, Allen community hospital, and various Cough and Cold Clinics. Initially, the primary purpose of this program was to foster early detection of deteriorating patients that might need referral back to the hospital, while also attending to patient needs so that some emergency department visits could be averted. Over time, the program expanded its mission to include mental health screening, education about self-quarantining, linkage of patients back to primary care, and connecting patients to resources such as food delivery, home oxygen, and pulmonary rehabilitation as those programs became available. Through this program, third and fourth-year medical students, referred to as Telehealth Guides, receive assignments of discharged patients referred by inpatient clinical teams via email or a newly-instituted EMR order. These student volunteers conduct daily calls, typically for 7-14 days after discharge, to check in with their patients using a standardized questionnaire assessing clinical symptoms and key vital signs if devices were available to patients in the home. Students supplement the standardized questionnaire by assessing patients according to their own clinical judgment. Students track phone calls and survey data using REDCap, a HIPAA-compliant web-based application that allows the administration of surveys and secure storage of responses. These surveys include questions regarding infectious symptomatology, mental health, and quality improvement. Surveys are programmed to generate red flags for symptoms that require notification of an on-call physician through an EHR app. On-call attending physicians, known as Escalation Doctors, are available for students to discuss patients potentially in need of increased levels of care as well as to address non-urgent questions that prior to this pandemic would have been directed to inpatient or primary care teams. Students follow patients from the point of discharge till they have sufficiently recovered to no longer require close follow-up care. Students gain an intimate understanding of issues that come up during the transition from the hospital to the home as well as how to partner with caregivers to promote their patients’ recovery. Thus, this program provides opportunities for students to closely participate in the care of patients while offloading other parts of the overstressed health system. Together, this program decreases the burden on an already overwhelmed health care system and fills important gaps in transitions in care. The RPM program follows a service-learning model, in which Telehealth Guides complete weekly reflections consisting of either written discussion boards or narrative medicine-based Zoom discussions, through which volunteers can interact with other students on various projects within the CSSC and from different programs, including medicine, nursing, and public health. Students lead weekly check-in meetings in which they discuss challenging cases and how best to integrate resources to optimize the care of their patients and continuously update a Telehealth Guide that captures protocols for taking care of patients remotely. Additionally, students also follow a continuous improvement model, keeping track of what did and did not go well during telephone visits, as well as asking patients about the quality of care they are receiving and improvement opportunities. Lastly, students are also responsible for training new Telehealth Guides that join RPM, and help disseminate this program to other parts of the health system. 

Contact

Sonya Besagar, B.A., B.S., Columbia University Vagelos College of Physicians and Surgeons, sb4054@cumc.columbia.edu

Project Category

Direct COVID-19 support

Mode of Participation

Virtual

Credit Status

For credit

Project Type

Telemedicine support

Keywords

Telemedicine, Telehealth, Service Learning, COVID-19, Remote Patient Monitoring