Telehealth for Wound Management During the COVID-19 Pandemic: Case Studies.

BACKGROUND: Prior to the COVID-19 pandemic, the Cardiovascular Surgery (CV) service of an academic medical center conducted a quality improvement project to decrease readmissions to the hospital from 2 rehabilitation facilities using telehealth via video calling. This initiative became of great importance with the COVID-19 pandemic because it helped the CV service better navigate and more efficiently meet the patient care needs associated with patient care restrictions. The CV service had to quickly evaluate and implement measures to reduce the rate of transmission of the coronavirus, which included adapting the clinic workflow to comply with state and federal recommendations. To minimize the interruption of clinical services and the associated revenue, a rapid transition from outpatient clinic visits to telehealth visits was implemented. CASES: Two cases reports of patients with wounds managed with 2 different telehealth platforms are described. Doxy.me platform allows the provider to e-mail or text a link to their personal waiting room for patients to join the video call. The second platform is Cisco Jabber platform to connect directly to the nursing unit at a skilled nursing or rehabilitation facility. CONCLUSION: Health care systems have had to adjust the manner in which they triage, evaluate, and care for patients using telehealth platforms that do not rely on in-person clinic visits during the COVID-19 pandemic. There are multiple telehealth platforms that require careful planning and treatment implementation. Each health care agency needs to choose the one or ones that function the best in their care setting.

Nightly Preoperative Huddle Email Improves Perioperative Efficiency.

BACKGROUND: Our institution created a nightly "Huddle" email for all staff involved in patient care, detailing the next day's cases. This study evaluated the impact of the Huddle email on perioperative efficiency and identified factors associated with operating room delays. METHODS: A total of 1080 first start, open, nonemergent cardiac operations were stratified as Pre-Huddle (January 2013-June 2015) or Huddle (July 2015-January 2017). Scheduled start-to-in-room time (delay time), in-room-to-incision time, and total minutes utilized were analyzed. On-time starts were defined as a delay time of 0 minutes, and long delays were defined as delay time of more than 15 minutes. Long delays were compared with other cases based on preoperative factors. Multivariate regression identified independent predictors of delay time. RESULTS: The analysis included 643 Pre-Huddle and 437 Huddle cases. After Huddle implementation, delay time decreased by 2 minutes (9 minutes Pre-Huddle vs 7 minutes Huddle, P < .001). However, time to incision increased (70 minutes vs 73 minutes, P = .002), as did minutes utilized (373 minutes vs 394 minutes, P = .002) in the Huddle era. On-time entry increased 46% (5.0% to 9.2%, P = .007), and long delay decreased 26% (33.3% vs 24.3%, P = .002). Long delay was associated with urgent cases (58.2% vs 28.6%, P < .001), non-Society of Thoracic Surgeons Predicted Risk of Mortality cases (46.9% vs 34.1%, P < .001), and less surgeon experience (7 years vs 9 years, P < .001). Delay time was independently predicted by urgent status (+10.17 minutes), surgeon experience (-0.15 min/y), lung disease (+5.43 minutes), and non-Society of Thoracic Surgeons Predicted Risk of Mortality (+5.44 minutes) on multivariate regression. CONCLUSIONS: Implementation of the Huddle improved delay time, on-time entry, and long delay. Strategies focused on optimizing perioperative care are beneficial for multidisciplinary teams.