Leveraging virtual care management

Hello, my name is Brad Crater. As a dedicated masters prepared RN with 20 years’ experience at healthcare facilities throughout New England and New York I’ve transitioned from clinical practice to the healthcare informatics and population health fields.  In this video I want to apply my knowledge of care management practices with the goal of helping you improving the efficiency and effectiveness of your clinical setting through utilization of telephonic care management to respond to the coronavirus pandemic.  Depending where you are relative to the surge the material covered may be helpful in the face of managing the influx of patients or preparing for a potential resurgence.

Many of our clients had already begun investing in a scalable care management infrastructure prior to the unanticipated events of COVID 19, as a way to support population health initiatives and quality improvement more broadly, and now they have pivoted these resources to help in the fight against COVID-19 by using telephonic are management in an effort to respond to the coronavirus pandemic by reducing emergency room visits and to slow the surge of patients being admitted to their hospitals.  I believe that by using care coordination tools, such as assessments and care plans, for rapid deployment of standardized telephonic care management processes your organization can reduce the number of in-person visits and subsequent risk of transmission of infection, as well as perform early symptom identification and triaging as a mitigation strategy to contain community spread and maintain safe hospital capacity.

One of the first needs to address is the development of a rapid and effective COVID-19 screening process.  Using the CDC’s phone advice tool you can quickly development a protocol triage system and embed into your care coordination program.  Once your care management team has their list of patients I recommend starting a triage to evaluate for life-threating conditions, including but not limited to:

·        Extreme difficulty breathing

·        Severe or persistent pain or pressure in the chest

·        Severe constant dizziness or lightheadedness

·        Acting confused or unable to wake up

·        Slurred speech

·        New onset seizures or seizures that won’t stop

If any of these conditions are reported the patient/caregiver should be instructed to call 911.  If not, the care manager can move on to a general COVID-19 symptom and exposure assessment.  Symptoms that should be assessed are:

·        Fever

·        SOB

·        Severe SOB

·        Hemoptysis

·        Low BP

·        Runny or stuffy nose

·        Sore throat

·        Muscle, body aches or headaches

·        Fatigue or malaise

·        N/V diarrhea

Exposures that the care manager should be asking about include if the patient has had any contact with someone with a known diagnosis of COVID-19 OR live/visited an area where COVID-19 is spreading in the community.

Additionally, the care manager should also be assessing for high-risk conditions and special circumstances, such as being healthcare personnel.  I’ve seen that organizations which take an analytic approach to identifying patients in their community, who are at a higher risk for exposure and developing serious illness from COVID-19, and pushing these lists to their care management team for proactive assessment of possible COVID-19 patients, have made their response and triage of the community much more efficient.

Once the care manager’s assessment is complete they should now determine their patient’s disposition, such as:

·        Urgent medical attention is needed/Go to the ED

·        Call a provider within 24 hours

·        Contact facility occupational health provider

·        Stay at home, call provider if you get worse

·        Provide education

I recommend that no matter what your patient’s disposition is, you apply a care plan.  Prioritizing consistent, preventative care facilitated by a patient-accessible care plan will provide continuity of care, and help the patient engage in self-care activities to protect themselves and their community. Each care plan should contain at least one problem, goal, intervention and follow-up at pre-defined intervals.  Using structured care plans will also allow your organization to perform a detailed analysis of their response to the pandemic and develop best-practices for the future. We have seen our clients employ many different care plan types, such as:

·        Respiratory Infection Prevention

·        COVID-19 Infection Management

·        COVID-19 Isolation

·        COVID-19 Quarantine

In the face of this pandemic our healthcare systems can best prepare and manage the outbreak in their communities by following guidelines and recommendations set forth by federal and global institutions, as I’ve outlined in this video.  Telephonic care management programs are vital in supporting outbreak management and should be leveraged to their full potential and I hope that my experience in providing these programs will be helpful to all health systems across the nation facing this challenge. Thank you, and be well.