Dear Editor,
Parents discharged from the pediatric emergency department (ED) often require follow-up within 24–72 h for a clinical reassessment [1]. With the COVID-19 pandemic, securing follow-up care became problematic, with some community primary care providers changing their availability or even closing their office entirely [2]. To solve this challenge, our ED developed an innovative program to care for patients—virtual follow-ups. Virtual follow-ups were a logical extension of the already established success of virtual initiatives within the pediatric emergency department [3, 4]. The intention of these visits was to help families care for their children at home while preventing unnecessary ED visits, especially during peak pandemic times.
Our suggested criterion for virtual follow-up visits was established at the outset and included patients with a single system complaint, a high likelihood to return to the ED as determined by the treating clinician, consent to contact and English speaking. At discharge, the patient and their caregiver were offered an option for a virtual follow-up visit, and if they agreed, were given a paper handout outlining when the appointment would occur. The family would receive an email within 24 h with a Zoom link for the appointment. They were seen up by our ‘virtual physician’, a role established earlier in the pandemic [5].
From February to April 2021, we enrolled 226 patients. 22 patients were unable to be contacted or did not attend the appointment, leaving 204 who were assessed (91%). The median age of patients contacted for virtual follow-ups was 23 months.
Of the 226 patients, nine (4%) returned to the ED within 72 h and needed to be admitted to hospital. 8/9 (89%) were told by the virtual clinicians to come to the ED for assessment, and 1/9 (11%) came back to the ED prior to the virtual follow-up.
A parental satisfaction survey (n = 31) showed that the follow-ups helped families manage their child at home. Parents gave the follow-ups an average 94 on a scale of 0–100 in terms of “how helpful” the follow-up was. Qualitative comments included “incredibly helpful” and “I hope it continues after the pandemic”. There were no negative comments.
This workflow has become established in our ED and will likely find utility in future. We have shown it is valued by families, and could offer an option for providers to assure that follow-up is made for certain pediatric patients when traditional outpatient follow-up is either unavailable or impossible.
Sincerely,
Daniel Rosenfield, Sasha Litwin & Olivia Ostrow.
References
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