Monitoring COVID Patients from Afar

Monitoring COVID-19 Patients from Afar

How innovative telemedicine technology and teamwork helped save lives

During one of the most isolating times in human history, technology made some unexpected connections at the

University of Miami Department of Medicine. In July 2020, the department

launched the UHealth Televigilance Program, allowing physicians to remotely

monitor and care for qualifying COVID-19 patients. No one could have guessed its impact on the

fellowship and camaraderie shared by Department of Medicine internists. Though already a cohesive

team, UHealth providers rallied around this innovative device and united further to save lives while

relieving strained hospital resources in the process.

“We all had a call to action to make a positive difference so quickly,” says Sabrina Taldone, M.D., M.B.A., medical director of the UHealth Televigilance Program and associate program director of the Internal Medicine Residency Program at the Miller School of Medicine.

“Everyone was on the same page about how to get these patients home safely. We were able to align goals across multiple ancillary services, as well as different parts of the hospital.”

Physicians, nurses, and therapists came on board during the pandemic to facilitate the safest hospital-to-home transitions of care. As of last year, COVID-19 patients who met the criteria for discharge were equipped with a TytoCare home health apparatus that electronically recorded and transmitted timely health status information to healthcare providers. Implemented under the UHealth Televigilance Program, the remote monitoring device assisted in decreasing the length of hospital stays, curtailing readmissions, and freeing hospital beds. Historically, the data captured by the TytoCare device could only be viewed in the TytoCare platform by logging into their website. The UHealth IT team built out an Epic® integration so that all submitted data, progress notes, and communications could be kept in one place in Epic®, thereby improving patient safety by making the process seamless for the healthcare teams to care for patients

in the program. For example, patients submitted vital signs daily via their TytoCare device at home. Vital signs then appeared in the provider’s Epic® (UHealth Chart) In Basket with enhancements that drew attention to abnormal vital signs so they could be acted upon.

“Dr. Cristina Pravia and I would follow patients’ vitals. If there were abnormal vital signs, we would contact the patient and initiate a telehealth visit to figure out how ill they were,” recalls Taldone. “We would help to triage them to a higher level of care if necessary or, if there was something we could help them with through that encounter, give them guidance on how to help alleviate their symptoms, what to be looking for, and when to go back to the hospital.” Telemedicine has bridged many gaps that social distancing created during the pandemic, but only up to a certain level. With the TytoCare device, physicians have been

able to accomplish much more, completing comprehensive exams of patients who might otherwise need to remain hospitalized. During the pandemic, 67 patients were monitored. Fifty of these patients were discharged from the hospital, while 17 were discharged from the emergency room. Notably, 41 percent of the COVID -19 positive patients being monitored in the program were discharged home on oxygen delivered through a nasal cannula.

Tomas Camacho, 73, was discharged from UHealth Tower with oxygen after staying several days in the hospital for COVID-19 pneumonia. His son, Thomas Camacho, appreciated how much the device helped him as a caregiver.

“The TytoCare device has been amazing because we’ve been able to send all the information directly to the doctor, and she has contacted us and been very helpful in everything. It gives you a little ease,” Thomas Camacho says.

At one point, Mr. Camacho’s vitals data showed that his blood pressure had dropped precipitously, and his oxygen saturation was low.

“After reviewing records from his hospitalization in the electronic medical record, I initiated a telemedicine visit with the patient and his son,” Taldone recalls. “Our visit revealed the patient had re-started his home medications for hypertension. After adjusting his medications, his blood pressure improved. By seeing the patient on screen, I also noticed the nasal cannula was not properly placed on his face. The patient and his family also needed education on how to appropriately titrate his home oxygen. With this support, we were able to help the patient avoid a call to 911 and a hospital readmission.”

“We’re actively looking into how we can learn from this experience. We were able to monitor COVID-19 patients remotely with this device, so we’re trying to find what other disease states that could potentially be a good fit for this kind of technology.” — Sabrina Taldone, M.D., M.B.A.

“If there were abnormal vital signs, we would contact the patient and initiate a telehealth visit to figure out how ill they were.”

— Christina Pravia, M.D.

While the pandemic revealed and set limitations on healthcare systems throughout the world, it also challenged participants to defy those limitations. UHealth met that challenge through collaboration and innovation, and in doing so, emerged stronger than ever to face the demands of tomorrow. Today, UHealth is conducting pilot projects using the TytoCare device and exploring additional opportunities within the ambulatory realm, such as for patients in the cystic fibrosis clinic. TytoCare is also being At a time when hospital beds were scarce, department faculty used the innovative Tytocare considered from an acute on- home health device, which allowed eligible Covid-19 patients to be discharged and monitored demand perspective for specialty safely from home. consultations.

“We’re actively looking into how we can learn from this experience. We were able to monitor COVID-19 patients remotely with this device, so we’re trying to find what other disease states that could potentially be a good fit for this kind of technology,” Taldone says. “COVID-19 was a good model for telemedicine, and remote care may not be ideal for all diseases, but there are certainly ones where we can improve patient care and convenience of care, while also improving quality outcome measures.”