Telehealth Goes Mainstream

By Scott Behm, Section of Surgical Disciplines

Stay home, and if you must go out, wear a mask. These two guidelines have been instilled since the beginning of the COVID-19 pandemic. For patients in need of care, however, staying home and delaying care can pose a whole new set of risks. Waiting is not always an option.

Since March 2020, telehealth visits at Duke have skyrocketed from a handful of visits system-wide per week, to a fundamental pathway to care. For ENT care providers and clinicians in the Department of Head and Neck Surgery & Communication Sciences, telehealth has been an especially important strategy. ENT care frequently involves scoping of the throat or nose, which increases the risk of aerosolizing the virus.   

Chief of the Division of Pediatric Otolaryngology Eileen Raynor, MD, trained on the telehealth platform several years ago, but rarely made use of it until this year. Several of the obstacles to telehealth becoming mainstream were quickly overcome when social distancing became a necessity.

“We used telehealth for some post-operative care, but we weren’t using it for new patients or follow ups,” says Dr. Raynor. “Now, we’ve been doing a lot of follow-up patients and a few new patients. You can get a ton of information from history and at least have a plan that you can implement the next time you see the patient in person. We have seen some new patients with sleep disorders, breathing issues, snoring, neck masses, allergy symptoms, noisy breathing, things where they will need an intervention, but we can at least troubleshoot through the video visit and come up with a game plan and go from there.”

Not all care in ENT can be provided through telehealth. Surgical oncologist and Assistant Professor of Head and Neck Surgery & Communication Sciences Russel Kahmke, MD, says telehealth is a great tool, but not a replacement for in-person care.

“As a surgical specialty, we utilize procedures in the work-up and treatment of our patients,” Dr. Kahmke says. “We scope people, we do invasive testing like biopsies, and all of that really requires the person to be with you. With telehealth, you can meet someone and learn their story and get things teed up, so that when we can be together, it will be a more directed and straightforward encounter.”

As clinics have implemented new protocols to make it possible for a larger volume of in-person encounters, the health and safety of patients, clinicians, and staff have been at the forefront of each decision. David Kaylie, MD, Chief of Otology, Neurotology, and Skull Base Surgery, says that much care and attention have been given to this process.

“The main thing we have to think of is patient safety, and our own safety,” Dr. Kaylie says. “We have to do this very carefully. We’ve spent a lot of time figuring out how many patients we can have come through the clinic and maintain social distancing, and maintain the ability to clean everything between patients, and maintain as little contact as possible. Using new features in MyChart, patients can check in there and pay their co-pays, and answer a lot of questions they are usually asked. That speeds up check-in times. We make sure our providers have enough space in their workrooms. We also spent a lot of time on PPE protocols.”

Even with these procedural changes, it is not feasible to increase clinic volume to pre-COVID-19 levels, at least for the foreseeable future. Drs. Raynor, Kahmke, and Kaylie agree that patient response to telehealth have been mostly positive. For patients wishing to avoid risk of COVID-19, virtual visits remain a viable substitute for in-person contact. Telehealth is here to stay, and will continue to evolve based on patient need.     

“The real question is how we will use this technology moving forward,” says Dr. Raynor. “This situation is proof of concept that it is possible, and we will need to think creatively about ways that we can utilize it in the future.”