Who and How: Telemedicine Eligibility and Participant Guidelines in the Ambulatory Setting

Introduction: Telehealth use has dramatically increased due to the COVID-19 pandemic. Yet there are significant gaps in evidence regarding the clinical appropriateness of synchronous visits for ambulatory telemedicine that are under the umbrella of telehealth and defined as video appointments between patients and providers. As a result, there are few sensible guidelines for day-to-day practice, resulting in a lack of standardization and risk of suboptimal care. Methods: We developed patient inclusion/exclusion guidelines for use in ambulatory telemedicine. Complementary tools included guides on patient preparation, telemedicine physical exam, and provider etiquette. We analyzed telemedicine use by practice type and surveyed a subset of MaineHealth ambulatory practices regarding the applicability of the guidelines. Results: Volume and specialty distribution data show that although telemedicine volume increased significantly, use varied by specialty. Behavioral health providers used telemedicine the most, followed by primary care, medical specialties, and, finally, surgical specialties. Stratification intensified as restrictions on in-person care declined. Discussion: We observed the expected pattern of use by specialty type, given our inclusion/exclusion criteria. Although these criteria may be conceptually straightforward, implementation is not. We operationalized these concepts to ensure individual practices can adapt and implement these insights in a reproducible and predictable way, leading to increased standardization across the health system. Conclusions: Clinical teams need help determining how to best use telemedicine tools. Here, we provide practice-level guidelines focused on practical implementation. We hope this communication advances the effort to develop standards of care for telemedicine indications

Safe Care for Seizure Patients on an Epilepsy Monitoring Unit

Seizure patients admitted to an Epilepsy Monitoring Unit located within an academic tertiary medical center have a high potential to impact patient safety. As a result, a unit based team identified a need for a higher level of training for both their staff and float companions to ensure safe and standardized care for this group of patients. The goal of this quality improvement project was to create an educational tool that would assist 100% of staff in better recognizing and responding to seizures. Baseline metrics and root cause analysis demonstrated a lack of consistent information being taught, a poorly identified target audience as well as educators. Several countermeasures were instituted to include an educational video that standardized seizure and response education. Data collected post rollout demonstrated several positive outcomes to include zero safety events involving this patient population, meeting the goal of 100% of staff educated, and education being mandatory for new staff. Some of the next steps include expanding training to staff caring for pediatric epilepsy patients as well as a tele-sitters video monitoring system request for FY20 budget year

Women and Epilepsy

Presented by: Megan Selvitelli, MD MaineHealth | Maine Medical Partners Physician Lead, Neuroscience Service Line OBJECTIVES 1. Interactions between Birth Control and Antiseizure Medications (ASM) 2. Pre-pregnancy/pregnancy counseling in women with epilepsy 3. Fertility 4. Risks of seizures in pregnancy 5. Risks of ASM in pregnancy 6. Folate supplementation 7. Breastfeeding and ASMhttps://knowledgeconnection.mainehealth.org/obgyn_gr/1004/thumbnail.jp