Agility in Times of Uncertainty: Development of a Pediatric Telehealth Team

Purpose: The purpose of the pediatric COVID-19 care team (PCCT) was to provide a high level of pediatric care for pediatric patients who tested positive for the SARS-CoV-D (COVID-19) virus at any of the health system’s designated testing sites across the Midwest.

Description: When pediatric COVID-19 positive cases began to rise in early 2020, a small group of providers and nurses volunteered to initiate resources, deliver test results, and educate parents about the COVID-19 virus by telephone. In April 2020, leadership at the institution requested to formalize this team to provide a higher level of telehealth care. This team consisted of physicians and registered nurses (RNs) supported by operations, nursing leadership, and project management teams. The goals of the team were to provide medical support and education to families at home, keeping infected patients away from the clinic and facilitating containment of the virus. The workflows included scheduled calls to patients and families occurring several times throughout the isolation period. Initial calls, conducted by the provider on the team, included an assessment of current symptoms and a review of medical history to inform providers of risk for severe disease. Providers then delegated a follow-up call to the nurses on the team to provide program information, enrollment to the program, and connection to community resources. All subsequent calls during the isolation period were delegated to nurses. With time, chart reviews led the team to create needed workflow changes to efficiently manage local surges in COVID-19 cases, allocating resources to those most at risk for severe disease or most vulnerable due to socioeconomic status. Eventually, the bulk of the work transitioned to pediatric nurses in ambulatory care, centering on isolation and quarantine education and how to best access medical care. Informatics assisted in the development of reporting tools and electronic medical record lists to allow for efficient task management and communication. The use of patient online messaging, including bulk messaging, was optimized for those at minimal risk for complications from COVID-19 infection. In the current state, only those who are non-English speaking, are pregnant, are less than 6 months old, or are potentially eligible for monoclonal antibody therapies will receive a phone call from the PCCT. All others are informed of their test results and isolation information via electronic notification in patient online services or a letter mailed to the home.

Evaluation/outcome: Through ongoing program evaluation, the team was able to match the level of care to the acuity, risk, and socioeconomic status of the patient. Improvements in the workflow significantly reduced the volume of required resources while still meeting the needs of the patients. To date, there have been no adverse events reported related to the telehealth care of pediatric COVID-19 positive patients despite significant and ongoing workflow changes made by the PCCT.