Two of South Florida’s largest hospital chains have significantly changed how they practice medicine during the pandemic via telehealth.
Doctors and nurses at Baptist Health South Florida and Memorial Health System, like many other hospital groups and doctors’ offices, pivoted to the real-time platforms, freeing up hospital beds and giving patients an alternative to going to a doctor’s office during the COVID-19 pandemic.
“Telehealth is an emerging technology that allows us to communicate with patients at a distance,” said Eduardo Martinez-Dubouchet, M.D., who serves as Baptist’s medical director of telehealth services.
Baptist’s “care-on-demand” platform allows patients to access doctors for non-emergency care using a smart phone, tablet or computer.
Martinez-Dubouchet oversees the hospital’s “Tele-ICU” platform, in place since 2006, where a remote critical-care staff including nurses, nurse practitioners, pharmacies and physicians are available 24/7, he said.
“This allows for immediate attention to patients without any difficulties of having to walk to 15 rooms between hospitals or drive between hospitals,” Martinez-Dubouchet said.
The pandemic has led to a sharp increase in telehealth visits as hospital emergency departments were overwhelmed across the country.
Baptist also introduced Masimo, a virtual monitoring system that allows patients who do not require acute care to be discharged and have their vitals monitored by health teams while at home.
REMOTELY WATCH PATIENTS’ OXYGEN LEVELS
During the pandemic, doctors were able to remotely watch for silent hypoxia, which Martinez-Dubouchet described as “asymptomatic low oxygen levels in the patient that can cause deleterious effects, including death.”
Data from hands and wrists was transmitted via cellphones, or other electronic means, to Baptist’s Telehealth “logistics center,” where a medical team used a web-based application to monitor patients’ pulse oximetry, heart and respiratory rates.
“By doing so, we were able to keep thousands of patients at home and save the county a multitude of hospital beds that were in need for other conditions and COVID-related illnesses,” Martinez-Dubouchet said.
Baptist is looking to expand such services for non-COVID-related illnesses.
Although similar, the terms ‘telehealth’ and ‘telemedicine’ should not be used interchangeably, according to the Centers for Medicare and Medicaid Services (CMMS).
Telemedicine permits two-way, real-time interactive communication between doctors and patients from a distance, CMMS says. Telehealth refers to the use of telecommunications — and information technology — to provide health assessments, diagnoses and interventions across distance.
Aside from being a pandemic-borne game-changer, Telehealth has allowed healthcare systems to cut hospital stay times and facilitated en masse care.
Memorial Health System learned that with its COVID testing program at the 300-acre C.B. Smith Park in Pembroke Pines, where physicians, residents, nurses, psychiatrists, and other key state and federal staff provided COVID-19 testing.
“The C.B. Smith program was our public health response to the testing situation,” said Ahmed Shoreibah, M.D., program director of the internal medicine residency program at Memorial Healthcare System.
“It was almost a military camp type of set-up,” Shoreibah said, as he recounted National Guard troops, air-conditioned tents, thousands of people and visits from Gov. Ron DeSantis.
Memorial’s program differed from others, according to Shoreibah, in that those who tested positive were “triaged” into groups including those who were mildly ill, those who needed monitoring, and those who needed hospital care.
“This was an inflection point,” Shoreibah said. “We flipped on a dime and converted to telehealth in a very robust way.”
TELEHEALTH AT MEMORIAL’S TESTING SITE AT C.B. SMITH PARK
Memorial’s program included telehealth monitoring as well as reaching out to patients who tested positive or had screening symptoms. Depending on the symptoms, patients were advised to go to the hospital.
“A year ago, this was a very new thing,” said Shoreibah. “And it was a very scary thing for both doctors and patients.”
Medical staff stayed at C.B. Smith in case something happened with patients during testing, and doctors and nurses watched for symptoms including shortness of breath or dizziness.
Shoreibah described one life-threatening situation where a doctor he supervised determined that an elderly woman — with multiple health issues — urgently needed emergency care. However, she was getting worse at home and was reluctant to go to the hospital.
“I called her back and was very persistent,” said Dr. Alexandra Cugliari, a resident at Memorial who worked at C.B. Smith Park and conducted virtual visits to high-risk patients who tested positive for COVID-19. “It was obvious she had a worse-case trajectory and we couldn’t just leave her at home. It could have been fatal.”
Cugliari’s virtual bedside manner, followed by calling 911, led to the patient being admitted to Memorial with COVID pneumonia. The patient was treated, discharged and is back at home.
The adoption of at-a-distance medical care has improved non-emergency care, Cugliari says, especially in cases where there are transportation issues or people with dementia. The service is rapidly changing and works best with patients who do not require direct in-person interaction, such as routine matters and psychological services.
There are still some things that require in-person visits like taking one’s blood pressure, Cugliari said, as well as checking diabetic patients’ feet, but she has seen a palpable uptick in patient follow-ups.
“I am able to follow up with patients regularly that pre-COVID I only saw once a year,” Cugliari said. “Telehealth is absolutely here to stay.”