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A multidisciplinary telemedicine model for management of coronavirus disease 2019 (COVID-19) in obstetrical patients.
Reforma, Liberty G; Duffy, Cassandra; Collier, Ai-Ris Y; Wylie, Blair J; Shainker, Scott A; Golen, Toni H; Herlihy, Mary; Lydeard, Aisling; Zera, Chloe A.
Afiliación
  • Reforma LG; Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA.
  • Duffy C; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA.
  • Collier AY; Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA.
  • Wylie BJ; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA.
  • Shainker SA; Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA.
  • Golen TH; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA.
  • Herlihy M; Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA.
  • Lydeard A; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA.
  • Zera CA; Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA.
Am J Obstet Gynecol MFM ; 2(4): 100180, 2020 11.
Article en En | MEDLINE | ID: mdl-32838271
Background: The COVID-19 pandemic caused by the SARS-CoV-2 has increased the demand for inpatient healthcare resources; however, approximately 80% of patients with COVID-19 have a mild clinical presentation and can be managed at home. Objective: This study aimed to describe the feasibility and clinical and process outcomes associated with a multidisciplinary telemedicine surveillance model to triage and manage obstetrical patients with known exposures and symptoms of COVID-19. Study Design: We implemented a multidisciplinary telemedicine surveillance model with obstetrical physicians and nurses to standardize ambulatory care for obstetrical patients with confirmed or suspected COVID-19 based on the symptoms or exposures at an urban academic tertiary care center with multiple hospital-affiliated and community-based practices. All pregnant or postpartum patients with COVID-19 symptoms, exposures, or hospitalization were eligible for inclusion in the program. Patients were assessed by means of regular nursing phone calls and were managed according to illness severity. Patient characteristics and clinical and process outcomes were abstracted from the electronic medical record. Results: A total of 135 patients were enrolled in the multidisciplinary telemedicine model from March 17 to April 19, 2020, of whom 130 were pregnant and 5 were recently postpartum. In this study, 116 of 135 patients (86%) were managed solely in the outpatient setting and did not require an in-person evaluation; 9 patients were ultimately admitted after ambulatory or urgent evaluations, and 10 patients were observed after hospital discharge. Although only 50% of the patients were tested secondary to limitations in ambulatory testing, 1 in 3 of those patients received positive results for SARS-CoV-2 (N=22, 16% of entire cohort). Patients were enrolled in the telemedicine model for a median of 7 days (interquartile range, 4-8) and averaged 1 phone call daily, resulting in 891 nursing calls and 20 physician calls over 1 month. Conclusion: A multidisciplinary telemedicine surveillance model for outpatient management of obstetrical patients with COVID-19 symptoms and exposures is feasible and resulted in rates of ambulatory management similar to those seen in nonpregnant patients. A centralized model for telemedicine surveillance of obstetrical patients with COVID-19 symptoms may preserve inpatient resources and prevent avoidable staff and patient exposures, particularly in centers with multiple ambulatory practice settings.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Complicaciones Infecciosas del Embarazo / Control de Infecciones / Telemedicina / Atención Ambulatoria / COVID-19 / Obstetricia Tipo de estudio: Diagnostic_studies / Prognostic_studies Límite: Adult / Female / Humans / Pregnancy País/Región como asunto: America do norte Idioma: En Revista: Am J Obstet Gynecol MFM Año: 2020 Tipo del documento: Article Pais de publicación: Estados Unidos

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Complicaciones Infecciosas del Embarazo / Control de Infecciones / Telemedicina / Atención Ambulatoria / COVID-19 / Obstetricia Tipo de estudio: Diagnostic_studies / Prognostic_studies Límite: Adult / Female / Humans / Pregnancy País/Región como asunto: America do norte Idioma: En Revista: Am J Obstet Gynecol MFM Año: 2020 Tipo del documento: Article Pais de publicación: Estados Unidos