Atrium Wake Forest Baptist Health

Chi-Cheng Huang

The COVID 19 virus has been a disruptive innovator in the healthcare industry over the last two years. Cliché as it may, disruption often stimulates growth and doing things differently and possibly better. This 0.1 micron virus led to an mRNA vaccine being developed in less than 1 year. Over the last two years, we have witness the development of medications such as remdesivir, baricitinib, nirmatrelvir and ritonavir. Unfortunately, the COVID 19 virus also caused 6.2 million deaths and approximately 2.9 trillion dollars in economic losses worldwide. Although the concept of telehealth has been discussed for decades, insurance reimbursement, risk taking, and concerns about safety led to inaction at worst and cautious optimism at best. The delta and omicron variant surges created the needed stress test on health system around the world and the United States. Specifically at Atrium Wake and within the Atrium Enterprise, we have created and implemented Hospital at Home, Inpatient Virtual Consults and Virtual Hospital programs over the last two years.

The COVID 19 virus has been a disruptive innovator in the healthcare industry over the last two years. Cliché as it may, disruption often stimulates growth and doing things differently and possibly better. This 0.1 micron virus led to an mRNA vaccine being developed in less than 1 year. Over the last two years, we have witness the development of medications such as remdesivir, baricitinib, nirmatrelvir and ritonavir. Unfortunately, the COVID 19 virus also caused 6.2 million deaths and approximately 2.9 trillion dollars in economic losses worldwide. Although the concept of telehealth has been discussed for decades, insurance reimbursement, risk taking, and concerns about safety led to inaction at worst and cautious optimism at best. The delta and omicron variant surges created the needed stress test on health system around the world and the United States. Specifically at Atrium Wake and within the Atrium Enterprise, we have created and implemented Hospital at Home, Inpatient Virtual Consults and Virtual Hospital programs over the last two years.

“Although COVID 19 ignited the spark, it paved the path that our healthcare industry needed to spur innovation in telehealth.”

As the COVID 19 hospitalizations continued to surge in 2020 and 2021, the regional hospitals had challenges transferring patients that required subspecialty consultations to the tertiary academic center. Under the leadership of Dr. Shayn Martin, Dr. Brian Hieistand, and John Blalock, the inpatient virtual consult program was started at Atrium Wake. This innovation allowed for subspecialists to evaluate inpatients at outlying hospitals in a synchronous manner using web-based video conferencing technology. When consultant input is needed, the onsite clinician requests the consult through the electronic health record (EHR). Afterwards, the virtual consult navigator helps the consultant team arrange the synchronous virtual consultwith patients often in the afternoon. A free standing laptop on wheels allows the virtual consultant to discuss with the patient and the nurse the clinical case at the bedside. Subsequently, the consultative recommendation is placed in the medical chart to communicate with the on-site care team. The process not only permitted timely consultation but improved triaging capabilities of patients that could either remain at the regional hospital or benefit from transfer to the tertiary care center for interventions such as carotid endarterectomy, coronary artery bypass grafting or thrombectomy.

In winter of 2021 as a snowstorm and other competing factors hit western North Carolina, we started the virtual hospital program at Wilkes Medical Center which is designated to be in a critical access site by CMS. Upon its inception on Christmas Eve 2021, patients of lower acuity were designated as possible virtual hospital patients with their permission. Under the leadership of Dr. Harsh Barot, our virtual healthcare providers synchronously had rounds with our nurses at the bedside. The virtual cart was able to conduct a physical exam with our tele-stethoscope in which the clinician could auscultate the heart for murmurs, the lungs for rales, and abdomen for bowel sounds. Moreover, the camera pivoted 180 degrees and we were able to have discussion with the patient and families in a multidisciplinary fashion. Our on-site clinicians facilitate any opportunities that may arise such as a rapid response or bedside procedures.

Although COVID 19 ignited the spark, it paved the path that our healthcare industry needed to spur innovation in telehealth. Hospital at Home, Inpatient Virtual Consults, and Virtual Hospital provide care in a more efficient manner while not compromising quality or safety. These innovations will continue to grow and provide quality care beyond COVID surges and will be a mainstay in healthcare. The true beneficiaries are often our patients, their families, rural hospitals, and traditionally marginalized populations who may not always benefit from tertiary care access.