Telehealth platform allows kidney transplant process to continue during pandemic
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Researchers at Medical University of South Carolina have developed a telehealth platform that they deemed successful at ensuring the kidney transplantation process continues during the COVID-19 pandemic.
“The onset of the COVID-19 pandemic brought drastic and abrupt changes to health care delivery across the United States,” Vinayak S. Rohan, MD, FACS, of the division of transplant surgery at the institution, and colleagues wrote. “In South Carolina, patient access for nonurgent care was severely limited and the ambulatory clinics, traditionally used for kidney transplant evaluation, were closed. Thus, there was an urgent need to improvise a new COVID-19 compliant process for evaluating patients for possible kidney transplantation.”
As part of the virtual health platform, researchers first screened patients after reviewing medical records, dividing them into three risk-stratification groups labeled red, green or yellow. Patients in the “red” group were those least likely to be able to undergo transplantation due to medical conditions or who would likely need additional testing, whereas patients in the “green” group were those who were likely to be able to undergo transplantation and who would need little additional testing. The “yellow” group consisted of patients who were already on a waitlist at another center and, therefore, would likely need minimal testing. These patients were “fast tracked” or expedited through the virtual evaluation.
Virtual visits were then scheduled, followed by an in-clinic visit 2 weeks later.
“During this visit, the APP [advanced practice provider] orders the testing based on the patient’s preferences and documents the next step for the patient, which is relayed to the coordinator through the electronic medical record,” the researchers wrote. “Once the additional testing is complete, the patient is scheduled for an in-person visit. The second visit is an in-person appointment with the nephrologist or surgeon. This visit ensures that the patient receives all of the required pre-transplant education, listing labs and regulatory paperwork. The patient’s case is then taken to selection committee the following week to determine if they are ready for listing.”
According to Rohan and colleagues, 1,258 patients completed an evaluation between April and September (247 were “halted” prior to completing a full evaluation).
Of those who completed a full evaluation, 152 were presented to the selection committee and 113 were placed on the waitlist.
Results of a retrospective analysis suggested the telehealth platform was effective for continuing the transplant process, with a 46% reduction seen in patients in the active referral phase. In addition, more evaluations were completed within the virtual platform than were done before the pandemic (930 vs. 880). This led to similar additions to the 2020 waitlist compared with the 2019 waitlist.
“Because of the platform, we can give continuous access to patients in the kidney transplantation program even in the midst of a pandemic that has restricted access to the hospital,” Rohan said in a related press release. “We can provide access to kidney transplantation even for patients who have difficulty getting to the transplant center because of where they live or who have difficulties due to their socioeconomic status.”
According to Rohan, utilizing virtual medicine in this way can continue to help expedite the transplantation process even after the pandemic ends.
“We need to continue this practice in the future, even after the CARES [Coronavirus Aid, Relief and Economic Security] Act expires, and expand care across state lines so that patients can continue having access to medical care across all specialties,” he said.
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