LAUSR

Introduction Telemedicine use rapidly increased during the coronavirus disease 2019 pandemic. We assessed quality aspects of rapid expansion of a virtual urgent care (VUC) telehealth system and the effects of a secondary telephonic screening initiative during the pandemic. Methods We performed a retrospective cohort analysis in a single hospital network of VUC patients from March 1, 2020 through April 20, 2020. We abstracted demographic data, comorbidities, VUC return visits, emergency department (ED) referrals, and ED visits, dispositions, intubations, and deaths. We also reviewed incomplete visits. For comparison, we evaluated outcomes of non-admission dispositions from the ED: return visits with and without admission and deaths. We separately analyzed the effects of enhanced callback system targeting higher risk patients with COVID-like illness during the last two weeks of the study period. Results A total of 18,278 unique adult patients completed 22,413 VUC visits. Separately, 718 patient-scheduled visits were incomplete; the majority were no-shows. 50.9% of all patients and 74.0% of patients aged 60 years or older had comorbidities. Of VUC visits, 6.8% had a subsequent VUC encounter within 72 hours; 1.8% had a subsequent ED visit. Of patients with enhanced follow-up, 4.3% were referred for ED evaluation. Mortality was 0.20% overall; 0.21% initially and 0.16% with enhanced follow-up (p = 0.59). Males and black patients were significantly overrepresented in decedents. Conclusion Appropriately deployed VUC services can provide a pragmatic strategy to care for large numbers of patients. Ongoing surveillance of operational, technical, and clinical factors is critical for patient quality and safety with this modality.