Telehealth for COVID-19 in World Trade Center Responders: Meeting the Needs of This Unique Population

Details

• Personal Author:
  Byrne D ; Crowley L ; Mattson C ; Senay E ; Shukla G
• Description:
  On March 17, 2020, following lockdown orders, the Mount Sinai WTCHP ceased in-person clinic visits and began working rapidly to transition to virtual care. On March 21, the first Mount Sinai WTCHP patient reported shortness of breath and low fever. Unable to reach his private physician, he sent an electronic health record (EHR) message to his WTCHP provider seeking urgent care and advice. WTCHP clinicians worked together virtually to arrange for transfer to the ED. Given the unprecedented and uncertain nature of the pandemic and the possibility that this population had unique susceptibility to SARS-CoV-2 infection or progression to serious disease, it became clear that the WTCHP should prepare to respond to similar requests from patients with acute illnesses consistent with COVID-19 who were unable to access usual or urgent care. The circumstances necessitated a rapid and substantial reconfiguration of clinic services for WTCHP patients disconnected from usual care and concerned about SARS-CoV-2 exposure or infection. Program providers and clinic leadership felt a moral and ethical duty to rapidly pivot to acute services to fill the care gap and support patients during this unprecedented crisis. On March 23, the Mount Sinai WTCHP established a rapid response team - the WTC COVID Team - to serve patients disconnected from usual sources of care and seeking support and/or treatment for COVID-19. We sought to: 1) rapidly respond to WTCHP patients seeking care for suspected or confirmed COVID-19; 2) monitor disease severity, risk of decompensation, and need for ED transfer via frequent patient assessments; 3) maintain patients at home to reduce disease spread and unburden hospitals; and 4) maximize virtual care platforms to assist in appropriate evaluation and triage. ... This experience underscores the need for health systems to remain flexible to respond to unexpected challenges, particularly to ensure continuity of care for unique or vulnerable populations. Health care delivery systems and providers are facing new challenges and growing demands as a result of the increasing frequency of disasters (e.g., severe weather, pandemics). Health systems and providers must prepare to pivot from routine care to acute care provided everywhere to meet patient needs during disasters. Importantly, the opportunity to rethink systems in a broader sense should not be lost as the pandemic recedes - we must resist the urge to fall back on old habits. Frequent virtual contact with patients provided insight into how telehealth platforms and remote monitoring capabilities can speed the transformation to value-based care and achieve the triple-aim: improving the patient experience, enhancing population health, and reducing costs. Healthcare leaders, payers, and regulators must embrace and champion the "care everywhere" ethos facilitated by virtual care and catalyzed by the pandemic. This may be particularly true for the WTC first responder population - many of whom once again found themselves on the front line of a global disaster - and in need of care. [Description provided by NIOSH]
• Subjects:
  Communicable Diseases Emergency Responders Health Promotion Occupational Health Safety September 11 Terrorist Attacks
• Keywords:
  COVID-19 Emergency Responders Emerging Technology First Responders Health Care Health Programs Rescue Workers SARS-CoV-2 World Trade Center WTC
• ISSN:
  1076-2752
• Document Type:
  Text
• Funding:
  Contract
• Genre:
  Journal Article
• Place as Subject:
  New York ; OSHA Region 2
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  63
• Issue:
  11
• NIOSHTIC Number:
  nn:20063527
• Citation:
  J Occup Environ Med 2021 Nov; 63(11):e834-e837
• Contact Point Address:
  Emily Senay, MD, MPH, Assistant Professor of Medicine, Icahn School of Medicine at Mount Sinai, Department of Environmental Medicine and Public Health, 17 E. 102nd, New York, NY 10029-6023
• Email:
  Emily.senay@mssm.edu
• Federal Fiscal Year:
  2022
• Performing Organization:
  Icahn School of Medicine at Mount Sinai, New York
• Peer Reviewed:
  False
• Start Date:
  20170401
• Source Full Name:
  Journal of Occupational and Environmental Medicine
• End Date:
  20210331
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:255467c9c61463c6da8df1de80055ea63723eb9dc6370b99361902583e7ff860f3f10339a896b300cc8b135878e3322ee5a545a0dce5c2542c38dd731c9f0074
• Download URL:
  https://stacks.cdc.gov/view/cdc/222117/cdc_222117_DS1.pdf
• File Type:
  [PDF - 479.04 KB ]