Telemedicine Uptake in a Geriatric Assessment Center During the COVID Crisis

The Yale New Haven Hospital Adler Geriatric Assessment Center is an outpatient consultative service that provides comprehensive assessment of older adults. As elsewhere, at Adler the COVID crisis necessitated a rapid shift in mode of care following a total cessation of in-person visits from late March 2020 to the end of May 2020. While our patients initially preferred telephone visits, video visits as a proportion of total scheduled increased from an average of 6% in the last full week of March to 24% in the last week in May possibly indicating increasing familiarity and comfort with the technology during that time. In addition, while video appointments as a proportion of total scheduled dropped rapidly in June 2020 as face-to-face appointments were reintroduced, we found a steady increase in the proportion of video visits from 3% in the first week of July 2020 to 7% in the second week of February 2021. To test for significance, we ran logistic regression models modelling the dichotomous video-appointment variable as the outcome and week and day of week as continuous variables. We found there was a significant increase in the proportion of appointments delivered over video both during the time when no face-to-face video appointments were allowed (OR=1.21, CI=1.13,1.30) and later in the pandemic (OR=1.04, CI=1.02,1.06). Durbin-Watson statistics were run to ensure that autocorrelation could be ignored. Sensitivity analyses limiting the sample to those with non-cancelled appointments gave similar results. Future analyses will examine patient clinical and demographic characteristics that might influence these trends.

The importance of implementing inpatient virtual coverage in an endocrinology practice: lessons learned thus far from the COVID-19 pandemic

The COVID-19 pandemic has rapidly changed the landscape of medical care and the healthcare system needs to quickly adapt in order to continue providing optimal medical care to hospitalized patients in an efficient, effective, and safe manner. Endocrinology diseases are commonly present in patients with COVID-19 and often are major risk factors for development of severe disease. The use of electronic consultation and telemedicine have already been well-established in the outpatient setting but yet not commonly implemented in the inpatient arena. This type of remote medical care has the potential to provide a reliable delivery of endocrine care while protecting providers and patients from spreading infection. This short review intends to provide the initial steps for the development of an inpatient telemedicine endocrine service to patients with endocrine diseases. Telehealth will become part of our daily practices and has a potential to provide a safe and efficient method of consultative service.

Association of a Remotely Offered Infectious Diseases eConsult Service With Improved Clinical Outcomes

We performed a case–control study to evaluate an electronic, asynchronous infectious diseases consultative service at 2 rural hospitals within our health system. Patients with consultation via this platform (n = 100) had a significantly decreased odds of death at 30 days compared with propensity-matched controls (n = 300; adjusted odds ratio, 0.3; 95% confidence interval, 0.2–0.7; P = .003).

778. ID Rocks It: Infectious Disease Remotely Offered Consultative Knowledge and Support via Inpatient Telehealth

Background Infectious diseases (ID) consultation is associated with improved outcomes for patients hospitalized with infection. Provision of this service is not practical for many smaller hospitals, particularly critical access facilities. We sought to evaluate the impact of an electronic, asynchronous consultative service (“eConsults”) at two rural hospitals without on-site ID support. Methods Beginning July 2018, ID physicians at Mayo Clinic, Rochester, began performing asynchronous eConsults for patients hospitalized at Mayo Clinic Health System (MCHS) Albert Lea and MCHS Austin Hospitals. The first 100 consecutive patients receiving eConsults (cases) were compared with patients admitted for infection at the same facilities prior to pilot initiation (controls). Cases were matched to controls using 1:3 propensity match based on age, gender, race, and weighted Charlson comorbidity index. The primary outcome was readmission or death within 30 days after hospital discharge. Results Cases (n = 100) were more likely to have been hospitalized in the 6 months prior to the index hospitalization than controls (n = 300) (P < 0.0001). Patients with ID eConsult had a significantly decreased odds of death at 30 days (OR 0.3, 95% CI 0.2–0.7, P = 0.003) and there was a trend toward decreased readmission at 30 days (OR 0.4, 95% CI 0.2–1.1, P = 0.07). The mean length of stay was significantly longer for cases (5.7 days vs. 3.8 days, P =0.003). However, ID eConsult did not occur until 2.6 days into hospitalization, on average. Conclusion ID eConsultation was associated with lower odds of 30-day mortality. The increased length of stay may be mitigated by encouraging ID eConsults earlier during hospitalization. Inpatient ID eConsults represent a high-value proposition for patients and providers and a feasible means of expanding the reach of ID physicians. This novel care delivery model warrants further investigations. Disclosures All authors: No reported disclosures.

Palliative and End-of-Life Care in the Intensive Care Unit

Palliative medicine is the specialty that focuses on improving the quality of life for patients and families when the patients have serious or advanced medical conditions. The approach to care is patient centered and goal oriented. It can be performed at any stage of illness with or without a palliative medicine consultative service. All clinicians, including intensive care unit (ICU) physicians, who care for patients with serious or advanced illnesses should be able to provide adequate palliative care.

Case Study Analysis of a Consultative Service Delivery Model With Students With Speech or Language Impairments

This chapter examines the speech or language impairment (SLI) disability. SLI is a disability that can be serviced across settings with the support of both a speech-language pathologist and teachers from both regular and special education classrooms. The chapter also examines causes and characteristics, educational placement and interventions, and eligibility criteria for students with an SLI. The interventions presented are diverse and can be taught across the curriculum. Furthermore, the chapter examines two case studies at the elementary and middle school levels that highlight how the consultative service delivery model can be employed with speech and language students. The chapter concludes with a discussion about future trends in the consultative service delivery model with SLI students.

Development of a Virtual Benign Hematology Consultation Service: Results of a Pilot Project Involving 5 Medical Centers

Background: Benign hematology consultations constitute a sizable proportion of community hematology/oncology practices. There is a need for physicians with adequate training, experience, interest and expertise in evaluating and treating patients with these disorders1,2. Some hematologic issues are complex and require in-person histories and examinations, while others can be handled with advice electronically after a thorough chart review3. To improve the quality of the care provided to these patients, a virtual benign hematology consultative service was created. This program was developed in the setting of a multi-specialty group with a commonly accessible EMR, servicing 15 medical service area centers, each with their own hematology/oncology department. A pilot project was designed to evaluate the feasibility of performing benign hematology consults virtually with the goal of improving quality of care while simultaneously enhancing the expertise of the physicians performing the consultations. Methods: The setting for this program is a multi-specialty group with a capitated reimbursement model. A pilot project was begun in October 2017 between 2 participating medical centers and was expanded to include a total of 5 medical centers by April 2018. All non-urgent benign hematology consultation requests were submitted electronically through an 'e-consult' portal. Evidence based work ups for common hematologic conditions were developed with consensus amongst all 15 hematology departments and provided on the e-consultation landing pages. All urgent questions and in-patient consults were called in directly to an on-call physician. Results: Data from October 2017 through April 2018 are reported. During this time, there were 2013 consults submitted electronically for review. Of this, 1107 came under the non-specific 'Ask the Specialist' code, and 906 under a specific diagnosis code. Regarding the consults with a designated diagnosis code, anemia 239 (26.3%), abnormal SPEP 208 (22.9%), anticoagulation 142 (15.6%), thrombocytopenia 103 (11.3%), leukocytosis 73 (8.1%), thrombocytosis 56 (6.2%), erythrocytosis 45 (5.0%), leukopenia 40 (4.4%) were the most common inquires. The requests that came under the 'Ask the specialist' code included questions regarding iron deficiency, easy bruising, macrocytosis without anemia, elevated ferritin levels and an elevated PT/PTT to name a few . Of the 1107 'Ask the specialist' consults, 941 (85.0%) were handled with advice given electronically while 116 (15%) were triaged to an in-person appointment. When evaluating the specific diagnosis codes, 575 (63.4%) were handled with advice given electronically. The most commonly triaged diagnosis for in-person appointments were thrombocytosis (60.7%), leukopenia (50.0%) and thrombocytopenia (47.6%). 90.3% of the consultation requests were addressed within 24 hours. When evaluating the number of consults on each day of the week, there were an average of 32.7, 25.8, 19.6, 24.4 and 18.2 consults triaged Monday through Friday respectively. The time necessary to complete an electronic consult was calculated based on data from 7 hematologists with a sample size of 197 consults. It took an average of 14.47 minutes to complete each consultation when performed electronically (95% CI, 14.02 mins - 14.91 mins). This is similar to the time reported by Cecchini et al. in their experience with this program at the VA health system3. All referring physicians were surveyed regarding their perceptions of the program, scaling their responses from 1 to 5. When asked if the work-up algorithms were helpful, if the recommendations received were clear and whether it was easy to access the specialist, the weighted average responses were 4.60, 4.50 and 4.0 respectively. Conclusions: This was a pilot program to assess the feasibility of a virtual hematology consultative service. The initial success of the program shows that it is possible to provide high value consultations to referring providers in an expeditious manner that enhances quality of care by having experts focused in the area perform the evaluation. Patients are also spared a visit to the hematology/oncology clinic to discuss a benign condition, and therefore has the added benefit of reduced anxiety4. Future studies will involve measuring outcomes of patients who were managed virtually, and the effect of the recommendations on the utilization of laboratory tests. Disclosures No relevant conflicts of interest to declare.

2490 Research navigation services and onboarding: Succeeding in the research environment

OBJECTIVES/SPECIFIC AIMS: Describe (1) the components of the research navigation service and consultation/onboarding program, (2) use and adoption of the services, and (3) the overall satisfaction from the research community. METHODS/STUDY POPULATION: Duke offers 2 programs to support researchers: Research Navigation and Researcher Onboarding. The services aim to connect researchers to resources, offices, funding opportunities, and other collaborators. The general Research Navigation Service is an on-demand “hotline,” where navigators answer questions from researchers across the institution, helping them understand processes, best practices, and how to locate resources or potential collaborators. Navigators can be reached via the myRESEARCHhome portal, email, or by phone. The researcher onboarding program is a free 1:1 consultative service, focused on the researcher’s individual portfolio, stage of career, and immediate plans in the research arena. The goal is to equip researchers “from the start” to be successful. Researchers are identified via the new faculty hire list, or by referral. Both services are provided by the myRESEARCHnavigators team, who are trained in a variety of research areas, from basic to clinical to social sciences, and are familiar with Duke. RESULTS/ANTICIPATED RESULTS: Use of both services has increased substantially over the year. Of the almost 200 faculty members hired into the School of Medicine in 2017, ~75% have taken part in the onboarding program, and 91% have rated the service as 5-stars. The content of the sessions will be described. The Research Navigation service has fielded hundreds of calls since its inception, with topics including Equipment and Facilities (55 requests), Study start up (44 requests), Innovation and Technology (15 requests), and Regulation and Policy (25 requests). Categorization of requests, users of the services, and other information about the programs will be described. DISCUSSION/SIGNIFICANCE OF IMPACT: The navigation and onboarding services are proving to be a successful way to increase efficiency and understanding of processes and resources across the institution. Feedback from the users, coupled with high referral rates to the programs, suggests that the program is helping researchers feel better equipped with regard to their research planning, conduct, and analysis.

Models of care in tele-ophthalmology: A scoping review

The objective of this review was to identify and describe telehealth models of care for ophthalmic services. We conducted a scoping review of the literature to identify how ophthalmic care can be delivered by telehealth. We searched the PubMed database to identify relevant articles which were screened based on pre-defined inclusion criteria. For included articles, data were extracted, categorised and analysed. Synthesis of findings was performed narratively. The scoping review included 78 articles describing 62 discrete tele-ophthalmic models of care. Tele-ophthalmic models of care can be used for consultative service, screening, triage and remote supervision. The majority of services were for general eye care and triage ( n = 17; 26%) or emergency services ( n = 8; 12%). The most common conditions for disease-specific models of care were diabetic retinopathy ( n = 14; 21%), and glaucoma ( n = 8; 12%). Most models of care involved local clinicians capturing images and transmitting them to an ophthalmologist for assessment. This scoping review demonstrated tele-ophthalmology to be feasible for consultation, screening, triage and remote supervision applications across a broad range of ophthalmic conditions. A large number of models of care have been identified and described in this review. Considerable collaboration between patient-end clinicians and substantial infrastructure is typically required for tele-ophthalmology.