Remote Care for Pregnant Patients with COVID-19 Effective and Efficient, BIDMC Researchers Report

The telemedicine model likely prevented potential exposures and preserved hospital resources during first wave of the pandemic

BOSTON – In the spring of 2020, Massachusetts was in the thick of the first wave of COVID-19, reporting thousands of new infections daily. As part of Beth Israel Deaconess Medical Center’s (BIDMC) response to the pandemic, physician-researchers in the Division of Maternal Fetal Medicine in the Department of Obstetrics and Gynecology created a telemedicine model that allowed obstetricians and nurses to safely manage pregnant or recently postpartum patients with possible COVID-19 infections remotely. In an article published in the American Journal of Obstetrics & Gynecology MFM, the team reported that the telemedicine model was an effective means of managing obstetrical patients while preserving hospital resources and preventing potential staff and patient exposure to COVID-19.

“Although it is customary to have a low threshold for in-person evaluation or observation for many ailments that occur during pregnancy, there is a good reason to avoid in-person contact during the COVID-19 crisis,” said corresponding author Liberty G. Reforma, MD, Maternal Fetal Medicine fellow. “Based on the literature regarding non-pregnant patients with COVID-19, we hypothesized that about 80 percent of cases would be able to be managed entirely at home, so we implemented a clinical quality improvement initiative to safely monitor patients with suspected or confirmed COVID-19 remotely.”

From March 17 to April 19, 2020, a multidisciplinary team led by senior author Chloe Zera, MD, MPH, and comprised of obstetrical physicians and ambulatory obstetrics and gynecology nurses with experience in providing prenatal and postpartum care monitored 135 pregnant or postpartum patients with possible COVID-19 infections using a telemedicine model. Upon enrollment, obstetrical nurses assessed patients’ symptoms via telephone, calling patients daily for a median of seven days. Patients reporting severe symptoms were appropriately referred to the emergency department or ambulatory care. Nurses made a total of 891 calls over the course of the month and physicians made 20 calls.

During the four-week initiative, 116 patients were completely managed as outpatients, while 19 patients eventually required an in-person evaluation. Of these, 10 patients were deemed stable for continued outpatient monitoring and nine patients were admitted to the hospital.

“Although we do not have a control group to for comparison, we estimate that some fraction of the patients who were completely managed as outpatients would have presented for evaluation in the absence of this clinical program,” said Zera, who is also Assistant Professor of Obstetrics, Gynecology and Reproductive Biology Medicine at Harvard Medical School. “Our telemedicine model likely preserved hospital resources and prevented avoidable patient and staff exposures to the virus.”

Given the small number of enrolled patients and that the current article reflects only the first month’s experience with this telemedicine model, the researchers add that further work will be needed to assess the model’s impact on clinical outcomes and patient and provider satisfaction. However, the study authors suggest the telemedicine model could have applications that reach beyond the COVID-19 pandemic.

Noting that their remote care model served a diverse group of patients, including about 16 percent of patients who required interpreter services, Zera and colleagues suggest telemedicine may also have a role in improving access to high-quality prenatal and postpartum care. For obstetrical patients with barriers to access — such as geography, transportation, lack of time away from work, and lack of childcare — telemedicine models may enable more pregnant patient to access routine obstetric care.

“Nurses in our program were able to coordinate social work services, help navigate transportation barriers, provide a personal connection, and direct patients toward medical care when indicated,” Zera said. “Our findings help support the use of multidisciplinary telemedicine surveillance models for obstetrical patients during the pandemic and beyond. This model may help to improve the coordination of patient care between the outpatient and inpatient settings, improve patient and staff safety, and preserve hospital resources.”

Co-authors included Cassandra Duffy, MD, MPH, Ai-ris Y. Collier, MD, Blair J. Wylie, MD, MPH, Scott A. Shainker, DO, MS, Toni H. Golen, MD, Mary Herlihy, MD, and Aisling Lydeard, NP, all of BIDMC’s Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology.

This work was funded in part by a grant (K12HD000849) awarded under the Reproductive Scientist Development Program by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and Burroughs Wellcome Fund; and salary support from the Charles Koch Foundation.

The authors declare no competing financial interests.