610. Tele-ID Consult Services at Academic Medical Centers: Experience and Outcomes During the SARS-CoV-2 Pandemic
Authors: Andrzejewski Aryn M , Abdel-Massih Rima , Abdel-Massih Rima , Mellors John , Gupta Nupur 
Published: December 2021

Abstract

Background
Remote telemedicine ID consults (Tele-ID) appear to be effective for inpatients at community hospitals. Tele-ID is not used at academic medical centers (AMCs) because of the availability of onsite ID physicians. During the COVID-19 pandemic, intra-hospital Tele-ID was implemented because of insufficient PPE and the risk of SARS-CoV-2 exposure. To understand the effectiveness of intra-hospital Tele-ID, we compared outcomes following Tele vs. in-person ID consultation.

Methods
This is a longitudinal, matched, case-control study at two tertiary AMCs in Pittsburgh. Cases were evaluated via Tele-ID only (video, e-consults +/- inpatient phone call) between 3/1/20 – 5/31/20. Controls had in-person consults between 3/1/19 – 11/30/19 matched to cases by sex, race, ethnicity, transplant, age, BMI, Elixhauser score, and ID-specific coded diagnosis. Both groups were evaluated by existing general ID (GID) or transplant ID (TID) service physicians. Patients with COVID-19 diagnosis were excluded. Outcomes included ICU admission, hospital and ICU length of stay (LOS), in-hospital, 30 and 60-day mortality, and 30 and 60-day readmission.

Results
Among the Tele-ID group, 125 inpatients were evaluated by GID and 81 by TID. The majority were Caucasian, male, and non-ICU (Table 1). A broad range of ID diagnosis were made, most commonly bacteremia and pneumonia (Fig 1). Average hospital LOS post-ID consult was 6.26 days (GID) and 6.5 days (TID). For ICU patients, average LOS was 12 days (GID) and 7.6 days (TID). There were 5 (4%) and 3 (3.7%) in-hospital deaths, and 3 (2.4%) and 5 (6.2%) deaths at 30 days for GID and TID, respectively (Table 1). 65 cases could be matched to 633 controls by exact ID coded diagnosis (Table 2). Comparison of Tele-ID cases to in-person controls showed shorter ICU LOS (118.1 vs 269.2 hours; p = 0.002) and lower 30-day readmission (5.1 vs 17.3%; p = 0.004) for cases (Table 2). ICU admission and mortality were similar.

Conclusion
During the pandemic, intra-hospital Tele-ID proved to be an effective alternative to in-person ID consults at large AMCs, as evidenced by shorter ICU LOS and lower 30-day readmission for Tele-ID, and no difference in mortality. This experience suggests that Tele-ID could be used at AMCs as an alternative to in-person consults in non-pandemic settings.

Disclosures
Rima Abdel-Massih, MD, Infectious Disease Connect (Employee, Director of Clinical Operations) Rima Abdel-Massih, MD, Infectious Disease Connect (Individual(s) Involved: Self): Chief Medical Officer, Other Financial or Material Support, Other Financial or Material Support, Shareholder John Mellors, MD, Abound Bio, Inc. (Shareholder)Accelevir (Consultant)Co-Crystal Pharma, Inc. (Other Financial or Material Support, Share Options)Gilead Sciences, Inc. (Advisor or Review Panel member, Research Grant or Support)Infectious DIseases Connect (Other Financial or Material Support, Share Options)Janssen (Consultant)Merck (Consultant)