340 - Harbor-UCLA's Infant Scale Program: maintaining clinic access during the COVID-19 pandemic

Poster Number: 340
Publication Number: 340.345

Rachel A. Kim, Harbor UCLA Medical Center, Torrance, CA, United States; Darien Nguyen, Kaiser Permanente Pediatric Care Center, Fairfield, CA, United States; Laura Figueroa-Phillips, University of California, Los Angeles David Geffen School of Medicine, Downey, CA, United States; Soina K. Dargan, David Geffen School of Medicine, Long Beach, CA, United States; Maryanne Chumpia, University of California, Los Angeles David Geffen School of Medicine, Torrance, CA, United States; Tanesha Moss, Harbor Ucla Medical Center, Ladera Ranch, CA, United States

Background: At Harbor-UCLA Medical Center, infection prevention needs of the COVID-19 pandemic lowered clinic capacity for in-person visits.

Objective: By adopting telehealth video visits for low-risk infants, our clinic sought to decrease the average number of in-person visits per infant discharged from the nursery from 2 to 1 (in the first 21 days of life) by June 2021, thus maintaining access to care for all infants—especially those born to mothers with COVID-19.

Design/Methods: In June 2020, we began to assess infants as low or high risk for readmission (e.g., for hyperbilirubinemia, weight loss, etc.) and offer follow-up via video visits with take-home scales to low-risk infants. All other infants were given in-person visits; parents of low-risk infants could opt for in-person visits. Risk assessment occurred at the time of discharge and was based on BiliToolTM (which calculates an infant’s risk for severe hyperbilirubinemia) and other clinical criteria (Fig 1). After the first follow-up, providers scheduled subsequent visits in-person, by video, or by phone per their judgment. We reviewed infants’ charts for the number and type of follow-up and the number and reason for readmission in the first 21 days of life. We analyzed data using statistical process control (i.e, XbarS and U) charts and bivariate Poisson regression. Baseline data is from January 2019 to May 2020; data collection is completed through June 2021.

Results: Average number of in-person visits per infant decreased from 2.1 to 1.9 post-intervention (Fig 2, p=0.010); total (any type) visits was unchanged (p=0.532). All-cause readmissions per 100 infants increased from 5.8 to 7.2 (p=0.274). Of 37 infants readmitted for phototherapy post-intervention, 32 had exclusive in-person follow-up.Conclusion(s): We moved toward but did not meet our aim. As hospital providers change often, we created a variety of reminders for the video visit option. In February 2021, video visits stopped as COVID-19 infections decreased. There was also low yield of returned scales despite calls to families. As for our readmissions, because all but five were exclusively seen in person, it is unlikely the increase was directly caused by our intervention and may instead be related to parallel increases in exclusive breastfeeding and early discharges. Video visits with take-home scales seem to be a safe option for low-risk infants; they offer benefits of parental ease for follow-up, preservation of clinic capacity, and limiting infectious exposures. As COVID-19 infections rise again, it is crucial to revisit this project with focus addressing these obstacles to reach our aim.
Rachel Kim CVRachel A Kim CV Dec 2021.pdf
In-Person Clinic VisitsFigure 2