Over the past three weeks, Massachusetts General Hospital has undergone a transformation. Like most US hospitals these days, a palpable tension hangs over the building. The halls are quiet and devoid of visitors, isolation wards are filling with patients, and staff are dressed in extensive protective gear. There’s an unusual stillness in the air.
The usual daily gaggles of doctors and residents moving from bed to bed to conduct rounds has been replaced by a lone physician, clad in protective equipment, escorting a laptop on a cart around the hospital. Doctors participate virtually through an app the hospital has configured to facilitate medical care while limiting potential exposure by staff. Some doctors join virtual rounds from a sanitized conference room down the hall where they sit 6 feet apart, others from their homes.
In the isolation wards, Covid-19 patients rest in rooms equipped with iPads mounted to IV poles using a gizmo designed to secure tablets to boats. The iPads include software that makes them virtual extensions of Mass General’s 2,000 nurses. Nurses can use the devices to check on and communicate with patients without donning masks, gloves, and other precious protective gear, and risk exposing themselves to the virus.
In the three weeks since the system was deployed, Mass General says its use of personal protective equipment, or PPE, has fallen by half, helping the hospital cope with a nationwide shortage. It has also converted longtime opponents of telemedicine in hospitals into fierce advocates of the technology.
As the pandemic worsens, hospitals from California to Texas to New York are hastily building virtual care systems using tablets and smartphones, with similarly promising results. Many began as slapdash efforts to provide patients with high-quality care and access to the outside world amid visitor restrictions and supply shortages, but hospital officials say they have been surprised by the programs’ impact.
“This digital surge that is preceding the actual Covid-19 patient surge is going to transform health care permanently in the United States,” said Dr. Lee Schwamm, who leads Mass General's Center for TeleHealth.
Other health care providers agree. The Harris Health System in Houston initially turned to tablets to help ration PPE by limiting the number of staff members who entered the rooms of Covid-19 patients in isolation at its three hospitals. Officials soon realized the program could do more for providers and patients alike.
Harris Health now uses the tablets to provide on-demand access to interpreters for non-native English-speaking patients, patient consultations with pharmacists and dietitians, and video chats with patients’ family and loved ones. On Wednesday, the hospital network deployed a new system designed to streamline end-of-life care and ensure that the families of patients in critical condition can be quickly contacted and brought to the patient’s bedside virtually to be with them in their final moments.
David Riddle, administrative director of patient experience, says he hopes the service will alleviate some of the emotional burden for providers on the front lines, who often are the only ones around a dying patient. “It’s not a perfect situation, but as a clinician, you might find some sense of relief or some of the burden lifted off of you knowing that the family was able to at least tell their loved one something, and be with them virtually,” he says.
At SUNY Downstate Medical Center, a hospital in Brooklyn that is transitioning to exclusively house Covid-19 patients, staff use a limited supply of donated iPads and smartphones to help isolated patients connect with their loved ones. Another five iPads on carts are used for video interpretation services in multiple languages, including sign language.
“The hearing impaired find the device extremely helpful and it provides a lot of confidence and comfort,” said Wren Lester, chief experience officer and director of patient relations at Downstate Medical Center. Lester says the hospital hopes to expand the program after the crisis.
Downstate isn’t currently using the technology to provide inpatient virtual care, like Mass General and others. The intensity of NYC’s coronavirus crisis has left staff little time to create such a system. “The numbers have been growing so quickly that we have to change [core aspects of our] process quite regularly just to deal with the surge of patients and manage the crisis,” said chief information officer Michele Scaggiante.
Staff at Saint Francis Memorial Hospital in San Francisco, home to the city’s first dedicated Covid-19 treatment unit, initially turned to tablets and smartphones to help connect patients with their loved ones after local officials banned most hospital visitors on March 14. Since then, the devices have been adopted for other uses throughout the hospital, says Dr. Kathleen Jordan, vice president of the hospital.
“We were dealing recently with an end-of-life situation and had actually quite a beautiful experience with extended family from multiple locations being able to be present in a virtual way,” recalls Jordan. It was the first time the hospital had used such technology with such a large audience and in an end-of-life experience, she says.
Doctors at Saint Francis use the devices to check on patients in the hospital. There are, of course, still many tests and procedures that must be done in person, but for those that can be conducted remotely, many clinicians are finding virtual appointments provide them with the opportunity for greater intimacy with patients, Jordan says.
At most hospitals, Covid-19 patients see few other people, all of them cloaked in masks, goggles, and gloves. “It’s a very frightening experience,” says Schwamm of Mass General. “With the iPad device in place, they get to interact verbally and in a reassuring way with a nurse who they can’t touch, but whose facial expressions they can now see.”
The adoption of inpatient telemedicine has also helped with staffing, by allowing more providers to participate in care, says Jordan, at Saint Francis. Immunocompromised and other at-risk providers who had been kept away from patients to protect themselves can now weigh in remotely. Doctors who feel healthy but are quarantined because of Covid-19 exposures are also now able to contribute, Jordan says, which has helped the hospital avoid dire personnel shortages.
In preparation for the influx of patients, Saint Francis set up a surge area to act as an extension of the hospital’s emergency room. The surge facility isn’t located in the same area as the ER, but ER physicians will be able to lead remote visits and consultations for the surge facility without having to leave their posts.
“People have this idea that remote work is not really for clinicians, and I think this is showing us otherwise,” says Juan Estrada who oversees Virtual Consults Services at Mass General. He’s spent years trying to get the tech into the hands of health care providers, but until recently says he met largely with resistance.
“Change is difficult in medicine. Historically, telehealth has been an exercise in pushing so that people begin to see how technology can make a difference,” says Estrada. “These last three weeks, we are not really pushing. We are being pulled. This huge community of providers is clamoring for these solutions now. It’s amazing.”
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