DeWitt, Jason

Background: Our institution implemented acute-care obstetric (OB) telemedicine (TeleOB) to address rural disparities across our health system. We sought to determine whether in situ simulations with embedded TeleOB consultation increase participants’ comfort managing OB emergencies and comfort with and likelihood of using TeleOB. Methods: Rural site care teams participated in multidisciplinary in situ OB emergency simulations. Physicians in OB and neonatology at the referral center assisted via telemedicine consultation. Participants were surveyed before and after the simulations and six months later regarding their experience during the simulations. Results: Participants reported increased comfort with TeleOB activation, indications, and workflow processes, as well as increased comfort managing OB emergencies. Participants also reported significantly increased likelihood of using TeleOB in the future. Conclusions: Consistent with previous work, in situ simulation with embedded telemedicine consultations is an effective approach to facilitate telemedicine implementation and promote use by rural clinicians.

INTRODUCTION: Prenatal visits via a virtual platform are increasingly offered to patients. Previous studies have shown favorable acceptance by patients. The COVID-19 pandemic dramatically accelerated adoption of this new technology. This study was designed to compare documentation of maternal blood pressure and weight between virtual visits and traditional face-to-face visits. METHODS: The study is a retrospective comparison of documentation of blood pressure and maternal weight between virtual and traditional face-to-face prenatal visits between January 2019 and June 2021. IRB exemption was obtained. The electronic medical record of a large midwest U.S. health system was utilized to identify prenatal visit encounters for all patients at all gestations. The visits were grouped into virtual visits and face-to-face visits. Data analytics were used to compare documentation of maternal weight, systolic blood pressure, and diastolic blood pressure for both subgroups. Data were further broken down by month to show comparison over time. Comparison was also made by gestational age. RESULTS: A total of 108,428 prenatal visits were identified. Of these, 7,004 (6.5%) were virtual visits. Appropriate documentation of blood pressure was absent in 3% of face-to-face visits and 46% of virtual visits. For the maternal weight, data were missing for 3% of face-to-face visits and 66% of virtual visits. CONCLUSION: Studies validating the safety of virtual prenatal visits are lacking. This analysis identifies obstacles that need to be overcome to improve the safety of virtual care.