Earlier this year, Atrium Health Levine Children's pediatricians foresaw an imminent treatment dilemma. They knew that more and more children would test positive for COVID-19 as spring would transition into summer – as would many mothers of newborns.
Yet the best thing for people with mild or asymptomatic COVID-19 is to remain home and quarantined. How, they wondered, can providers monitor these patients without asking them to leave home?
“As pediatricians, we need to role model good behavior,” says Brian Lurie, MD, newborn virtual hospital lead and medical director of Atrium Health Levine Children’s Myers Park Pediatrics. “That means encouraging parents to stay home with their children who are sick, or to stay home if they're sick. So we turned it around and asked, ‘How can we bring care to you? What do you need? Let us help you.’”
The pediatric virtual hospital was born.
Fortunately, Atrium Health had a running head start. Last year, teammates at North Charlotte Medical Specialists - Huntersville, led by Thomas Batchelor, MD, began to create plans and protocols for a virtual hospital that would provide at-home care for adult patients with chronic illnesses. When the potential of the pandemic became clear, these virtual hospital plans pivoted to adult COVID-19 patients and, soon after, to pediatric COVID-19 patients. Many patients who didn’t require the level of care of an Intensive Care Unit (ICU) could be monitored by providers around the clock from home.
Atrium Health Levine Children’s Pediatric Virtual Hospital, among first of its kind in the country, offers much-needed care for pediatric COVID-19 patients, as well as COVID-positive moms with newborns. Not only do these patients receive the care they need from the comfort of their homes, but they minimize the spread of the virus to others.
“For each patient that we enroll and we are able to manage at home, there’s an estimate that we’re preventing four to six other cases of COVID-19 that might have occurred in the community if that patient had been out and about,” says Nancy Tarte, MD, pediatric virtual hospital lead and senior pediatrician at Atrium Health Levine Children’s Davidson Pediatrics.
How the Pediatric Virtual Hospital Works
The pediatric virtual hospital combines next-generation innovation with old-time community medicine. High-tech tools pair with in-home visits from providers, the kind of house calls that haven’t been commonplace in medicine in nearly a century. Technology is important, but the human element of the virtual hospital is just as crucial.
For pediatric patients with mild or no symptoms, parents can monitor their children’s health, logging their symptoms each day on an app. Nurses check the children’s progress on the app each day, and they call the parents if any changes warrant an in-home visit or a shift in treatment. Patients who are unable to use the app due to language or technical barriers receive a phone call from nursing every couple of days. Patients are also able to reach out to nurses by phone if they have urgent needs.
For patients with symptoms that require more management – or for patients without access to smartphones, computers or broadband access – community paramedicine teams may visit patients’ homes to be the eyes and ears of a provider during a virtual visit. The team’s paramedics – outfitted in personal protective equipment to keep themselves and the patient and their family safe – bring a laptop to connect the family to the provider through a video chat. If needed, these paramedics can get an electrocardiogram (EKG) to measure the electrical activity of the heartbeat, put an IV in, or draw blood, all without requiring the patient to leave home.
The pediatric virtual hospital also allows providers to monitor babies born to COVID-positive moms. Before the baby leaves the hospital, the baby is tested for COVID-19 and the family schedules an appointment with the virtual hospital team. A couple days later, the paramedicine team visits the patient’s home to connect the baby and mom to a provider over video chat, and they collect the baby’s weight, heart rate and vital signs, and perform another COVID-19 test. Providers check in with the mom and baby every two to three days for two weeks to ensure that the baby remains stable.
This model isn’t just about bringing doctors’ appointments to patients’ homes but ensuring that patients’ needs are met while they quarantine at home. Providers ask if families have enough medicine, food, cleaning supplies, baby formula, diapers and—the season’s hot ticket item—toilet paper. Social workers are a vital part of the pediatric virtual hospital team, offering families help with prescriptions, food, social services and more to maintain whole-person health and well-being.
“Patients get connected to sources like food banks or financial resources, and we provide letters to their employers explaining why they can't come to work,” says Dr. Tarte. “By having pharmacists and social workers on this team, the virtual hospital has even made deliveries to patients of the supplies that they need. It’s incredible what they are able to do.”
As Always, Providing Care “For All”
Initially, the patients who embraced virtual visits had smart phones and computers. Atrium Health teammates recognized that too many people in the community were excluded from this life-saving care, so the approach shifted. By incorporating community paramedicine teams, providers could bring the technology to patients who needed it. Most of the babies in the pediatric virtual hospital have families who are on Medicaid.
“It allows us to continue seeing these babies without making the moms or other family members who are COVID-positive come into an office,” Dr. Lurie says. “This way, they don’t expose other people to COVID, and they don’t have to leave their home if they don’t feel well. So we're preventing further disparities of care for some of our underserved populations.”
The teams also offer translation services for more than 200 languages to families whose first language is not English to ensure our community members know how to protect themselves and provide communication in the way patients are most comfortable. They bring COVID-19 care into underserved neighborhoods that face disproportionate impact from the virus, allowing more people to quarantine at home and avoid going out to doctors’ offices and clinics.
“We're trying to decrease barriers, and that’s really a tenet of Atrium Health,” Dr. Lurie says. “It’s about delivering care, the best care for COVID-19, to all our patients – not just some of our patients. And that really makes me feel good about working here.”
The Future of Virtual Medicine
As the success of the pediatric virtual hospital has become clear, providers are brainstorming ways to expand this model in the future. Children with chronic illnesses, as well as families who have a hard time transporting children to appointments, could greatly benefit from at-home care. In the meantime, an empathetic and equitable model of care offers support to some of the smallest patients of the pandemic.
“That we can continue care during a hard time for these families without having to put the burden on the family to come to us – I think that's really special,” Dr. Lurie says.
Find updates on COVID-19 and learn where to receive care in our COVID-19 Resource Center.
