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  • January 14, 2022

    By Allison Larson, MD

    Whether you’re a winter sports enthusiast or spend the season curled up by the fireplace, the low humidity, bitter winds, and dry indoor heat that accompany cold weather can deplete your skin’s natural moisture. Dry skin is not only painful, uncomfortable, and irritating; it also can lead to skin conditions such as eczema, which results in itchy, red, bumpy skin patches. 


    Follow these six tips to prevent and treat skin damage caused by winter dryness.


    1. Do: Wear sunscreen all year long.

    UV rays can easily penetrate cloudy skies to dry out exposed skin. And when the sun is shining, snow and ice reflect its rays, increasing UV exposure. 


    Getting a sunburn can cause severe dryness, premature aging of the skin, and skin cancer. Snow or shine, apply sunscreen before participating in any outdoor activity during the winter—especially if you take a tropical vacation to escape the cold; your skin is less accustomed to sunlight and more likely to burn quickly.


    The American Academy of Dermatology (AAD) recommends sunscreen that offers protection against both UVA and UVB rays, and offers a sun protection factor (SPF) of at least 30.


    That being said, if you are considering laser skin treatments to reduce wrinkles, hair, blemishes, or acne scars, winter is a better time to receive these procedures. Sun exposure shortly after a treatment increases the risk of hyperpigmentation (darkening of the skin), and people are less likely to spend time outside during the winter.


    Related reading: 7 Simple Ways to Protect Your Skin in the Sun

    2. Do: Skip products with drying ingredients.

    Soaps or facial products you use in warm weather with no issues may irritate your skin during colder seasons. This is because they contain ingredients that can cause dryness, but the effects aren’t noticeable until they’re worsened by the dry winter climate.

    You may need to take a break from:

    • Anti-acne medications containing benzoyl peroxide or salicylic acid
    • Antibacterial and detergent-based soap
    • Anything containing fragrance, from soap to hand sanitizer

    Hand washing and the use of hand sanitizer, which contains a high level of skin-drying alcohol, cannot be avoided; we need to maintain good hand hygiene to stop the spread of germs. If your job or lifestyle requires frequent hand washing or sanitizing, routinely apply hand cream throughout the day as well.


    During the COVID-19 pandemic, I have seen a lot of people develop hand dermatitis—a condition with itchy, burning skin that can swell and blister—due to constant hand washing. Sometimes the fix is as simple as changing the soap they're using. Sensitive-skin soap is the best product for dry skin; it typically foams up less but still cleans the skin efficiently.


    3. Do: Pay closer attention to thick skin.

    Areas of thin skin, such as the face and backs of your hands, are usually exposed to the wind and sun the most. It’s easy to tell when they start drying out. But the thick skin on your palms and bottoms of your feet is also prone to dryness—and tends to receive less attention.


    When thick skin gets dry, fissures form. You’ll see the surface turn white and scaly; then deep, linear cracks will appear. It isn’t as pliable as thin skin. When you’re constantly on your feet or using your hands to work, cook, and everything in between, dry thick skin cracks instead of flexing with your movements. 


    To soften cracked skin, gently massage a heavy-duty moisturizer—such as Vaseline—into the affected area once or twice a day. You can also talk with your doctor about using a skin-safe adhesive to close the fissures and help them heal faster.


    Related reading:  Follow these 5 Tips for Healthy Skin

    4. Don’t believe the myth that drinking more water will fix dry skin.

    Contrary to popular belief, the amount of water or fluids you drink does not play a major role in skin hydration—unless you’re severely dehydrated. In the winter, especially, dry skin is caused by external elements; it should be treated from the outside as well. 


    The best way to keep skin hydrated and healthy is to apply fragrance-free cream or ointment—not lotion—to damp skin after a shower or bath.
    Some people need additional moisturizers for their hands, legs, or other areas prone to dryness.

    While some lotions are made better than others, most are a combination of water and powder that evaporates quickly. Creams and ointments work better because they contain ingredients that can help rebuild your skin barrier. 

    Look for products with ceramide, a fatty acid that helps rebuild the fat and protein barrier that holds your skin cells together. The AAD also recommends moisturizing ingredients such as:

    • Dimethicone
    • Glycerin
    • Jojoba oil
    • Lanolin
    • Mineral oil
    • Petrolatum
    • Shea butter

    For severely dry skin, you can try a “wet wrap” technique:

    1. Rinse a pair of tight-fitting pajamas in warm water and wring them out so they’re damp, not wet.
    2. Apply cream or ointment to your skin.
    3. Put on the damp pajamas, followed by a pair of dry pajamas, and wear the ensemble for several hours.

    Dampness makes your skin more permeable and better able to absorb hydrating products. If the wet wrap or over-the-counter products aren’t working for you, talk with a dermatologist about prescription skin hydration options. 

    Drinking more water isn’t the answer to dry winter skin. The best solution is to apply fragrance-free cream or ointment directly to damp skin. Get more cold weather #SkinCareTips from a dermatologist in this blog: https://bit.ly/3KbVUA1.
    Click to Tweet

     

    5. Don’t confuse skin conditions with dryness.

    Skin conditions are often mistaken for dry skin because peeling or flaking are common symptoms. Redness of the skin or itching in addition to dryness and flaking indicates a skin condition that may need more than an over-the-counter moisturizer.


    Skin cells are anchored together by a lipid and protein layer (like a brick and mortar wall). With very dry skin, the seal on this wall or barrier is not fully intact and water evaporates out of the skin’s surface. The skin will become itchy and red in addition to scaly or flaky. If you experience these symptoms, visit with a dermatologist.

    6. Don’t wait for symptoms to take care of dry skin.

    Be proactive—the best way to maintain moisture is to apply hydrating creams and ointments directly to your skin on a regular basis. Start by applying them as part of your morning routine. Once you get used to that, add a nighttime application. And carry a container of it when you’re on the go or keep it in an easily accessible location at work.

     

    You can’t avoid dry air, but you can take precautions to reduce its harsh effects on your skin. If over-the-counter products don’t seem to help, our dermatologists can provide an individualized treatment plan. Hydrated skin is healthy skin!


    Does your skin get drier as the air gets colder?

    Our dermatologists can help.

    Call 202-877-DOCS (3627) or Request an Appointment

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  • May 03, 2020

    By MedStar Health

    Congratulations to all MedStar researchers who had articles published in April 2020. The selected articles and link to PubMed provided below represent the body of work completed by MedStar Health investigators, physicians, and associates and published in peer-reviewed journals last month. The list is compiled from PubMed for any author using “MedStar” in the author affiliation. Congratulations to this month’s authors. We look forward to seeing your future research.

    View the full list of publications on PubMed.gov here.

    1. Pertuzumab, Trastuzumab, and Docetaxel for HER2-positive Metastatic Breast Cancer (CLEOPATRA): End-Of-Study Results From a Double-Blind, Randomised, Placebo-Controlled, Phase 3 Study

      The Lancet Oncology, 2020. DOI: 1016/j.ajem.2020.04.035

      Swain SM, Miles D, Kim SB, Im YH, Im SA, Semiglazov V, Ciruelos E, Schneeweiss A, Loi S, Monturus E, Clark E, Knott A, Restuccia E, Benyunes MC, Cortés J; CLEOPATRA study group.

    1. Outcomes of the Medial Femoral Trochlea Osteochondral Free Flap for Proximal Scaphoid Reconstruction

      Journal of Hand Surgery, 2020. DOI: 10.1016/j.jhsa.2019.08.008

      Pet MA, Assi PE, Yousaf IS, Giladi AM, Higgins JP.

    1. MitraClip 30-day Readmissions and Impact of Early Discharge: An Analysis From the Nationwide Readmissions Database 2016

      Cardiovascular Revascularization Medicine, 2020. DOI: 1016/j.carrev.2020.04.004

      Case BC, Yerasi C, Forrestal BJ, Wang Y, Musallam A, Hahm J, Torguson R, Ben-Dor I, Satler LF, Rogers T, Waksman R.

    1. A Philosophical Approach to the Rehabilitation of the Patient with Persistent Pain

      American Journal of Hypnosis, 2020. DOI: 1080/00029157.2019.1709152

      Appel PR.

    1. Timing of Intervention May Influence Outcomes in Blunt Injury to the Carotid Artery

      Journal of Vascular Surgery, 2020. DOI: 1016/j.jvs.2019.05.059

      Blitzer DN, Ottochian M, O'Connor JV, Feliciano DV, Morrison JJ, DuBose JJ, Scalea TM.

  • May 03, 2020

    By MedStar Health

    A new issue brief was released by the Agency for Health Research and Quality (AHRQ) as part of their contract with MedStar Health and partners, focused on developing additional capacity related to understanding and improving diagnostic safety.

    Operational Measurement of Diagnostic Safety: State of the Science is an issue brief from AHRQ’s Patient Safety Program, reports that although few healthcare organizations have implemented systematic measurement of diagnostic errors, nearly all can use existing resources to monitor diagnostic safety for learning and improvement. Diagnostic errors affect approximately 1 in 20 U.S. adults each year, and reducing their incidence is an AHRQ priority. The issue brief includes a “call to action” for healthcare organizations to begin measurement efforts using data sources currently available to them to identify and learn from diagnostic errors.

    This issue brief was authored by Hardeep Singh, M.D., M.P.H. and Andrea Bradford, Ph. D from the Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX. and Christine Goeschel, Sc.D., RN, FAAN, MedStar Health Institute for Quality and Safety, AHRQ Patient Safety Learning Lab Grantee, and AHRQ National Advisory Council member. Dr. Goeschel is also a Professor of Medicine at Georgetown University.

    “Measurement of diagnostic performance is necessary for any systematic effort to improve diagnostic quality and safety, yet the development of diagnostic safety measures remains in its infancy. Our intent is to provide pragmatic and feasible ways for organizations to start using measurement to identify, prioritize, and address local diagnostic safety opportunities.” said Dr. Goeschel.

    The issue brief has been accepted for publication in the peer-reviewed journal Diagnosis.

    This work is part of a multi-year MedStar AHRQ ACTION contract that funds work and expertise related to building capacity to improve diagnostic safety and clinical quality. MedStar Health has partnered with Dr. Singh and his team to develop novel resources, tools and programs aimed at reducing diagnostic errors and related patient harm. Read the press release on the contract here.

  • May 03, 2020

    By MedStar Health

    Researchers at MedStar Health sought to understand how communication between emergency medicine (EM) providers plays a critical role in delivering safe and effective care to patients. “Ten Best Practices for Improving Emergency Medicine Provider-Nurse Communication” led by A. Zachary Hettinger, MD, MS, from the MedStar Health National Center for Human Factors in Healthcare was published in The Journal of Emergency Medicine. This study identified communication needs of emergency medicine nurses and physicians, in particular, what information should be conveyed, by whom and the most appropriate time to convey the information based on the clinical scenario.

    The research used semi-structured focus groups and interviews to identify communication strategies and barriers associated with information sharing in emergency medicine. Nine EM nurses, eight EM attending physicians, and four EM resident physicians participated in five focus groups and one interview to address questions regarding how EM personnel use and share information about patients and clinical work, what information tends to be exchanged, and what additional information would be helpful to share.

    The interview sessions were audio recorded and transcripts were analyzed using a concept mapping approach. Eleven maps were developed to describe the role communication plays in patient outcomes comprised of: categories of information physicians needed from nurses and vice versa; methods of communication that could be utilized; barriers or obstacles to effective communication; strategies to enhance or ensure effective communication; and environmental or situational factors that impact communication.

    Participants described several communication-enhancing strategies and the research team produced ten strategies to help support effective nurse-physician communication. These strategies include:

    1. Communicate diagnostic assessment, plan of care and, especially, disposition plan to other team members as early as possible. Update the team of any changes to the plan.
    2. Communicate pending tasks/steps in the patient’s care as well as information regarding changes or holdups to tasks or orders.
    3. Communicate details regarding proactive diagnostic testing and therapeutic interventions.
    4. Don’t assume everyone has a shared understanding: recognized that you might have unique access to information and make sure that it is shared in a timely manner.
    5. Notify providers of any critical or unexpected changes in vital signs or patient status.
    6. Do not assume electronic orders substitute for verbal communication
    7. Use asynchronous communication for lower priority items to aid in prioritization.
    8. Adapt communication strategies based on team members’ experience level and existing relationships.
    9. Adapt communication strategies to the physical layout of the ED, especially in those facilities where nurses and physicians may have workstations out of sight from one another or where it is not obvious which staff members are on different care teams
    10. Use strategies that exploit provider experience level regardless of role hierarchy.

    The key findings of this study help provide insight on how to improve communication and patient care within the EM department. While the information needed by physicians and nurses was similar, discrepancies in knowledge occurred from timing of when a patient or family member was spoken to; differential access times to the EHR; complexities in information sharing among trainees, nurses, and physicians; or because each role may have had unique opportunities to access information.

    This research was supported by the Agency for Healthcare Research and Quality, United States (R01HS022542).

    The research team included A. Zachary Hettinger, MD, MS; Natalie Benda, PhD; Daniel Hoffman, BS; Akhila Iyer, MS; Ella Franklin, MSN, RN; R. J. Fairbanks, MD, MS from MedStar Health National Center for Human Factors in Healthcare in collaboration with researchers from Roth Cognitive Engineering; Department of Emergency Medicine, University of Florida, Jacksonville Medical Center; Department of Emergency Medicine, Georgetown University School of Medicine; and the Department of Industrial and Systems Engineering, University at Buffalo, The State University of New York.

    The Journal of Emergency Medicine, 2019. DOI: 10.1016/j.jemermed.2019.10.035

  • May 01, 2020

    By MedStar Health

    When you’re recovering from an injury or surgery, it’s common to see a physical therapist who can help you regain function and restore motion in your body. But did you know that there are many other reasons why you may need physical therapy (PT), even if you aren’t an athlete or bouncing back from an operation?

    Did you know there are many other benefits of #PhysicalTherapy other than recovery after injury or surgery? Physical therapist Jared Miller shares 8 ways PT can help #TreatPeople on the #LiveWellHealthy blog: https://bit.ly/2YkOogZ

    Click to Tweet

    A physical therapist is a healthcare specialist who can treat many lesser-known conditions beyond just sports-related injuries or post-operative therapy. They can provide evaluation and treatment in the clinic or often-times via video visit. Here are eight surprising reasons you may need physical therapy.

    1. Pelvic floor conditions.

    The pelvic floor consists of muscles and tissues that help men and women maintain correct posture as well as bladder, bowel, and sexual activity. When pelvic floor muscles are overused or injured, you may experience pain, incontinence, or other symptoms related to pelvic floor dysfunction (PFD). While it can be difficult to pinpoint the cause of pelvic problems, most frequently PFD occurs after childbirth, infection, injury, or trauma to the pelvis.

    Many people are surprised to know pelvic floor conditions can be diagnosed and treated by a physical therapist with advanced training in pelvic floor therapy. A pelvic floor specialist can help with the following:

    • Endometriosis
    • Menopause symptoms
    • Painful intercourse
    • Pelvic pain
    • Pregnancy and postpartum recovery
    • Urinary incontinence

    Although common, pelvic pain is not normal. If you’re experiencing pelvic pain, sexual dysfunction, or incontinence, a physical therapist specializing in pelvic floor therapy can help.

    2. Cervicogenic headaches.

    If you’ve experienced an ache that works its way from the base of your neck and up your head, then you know what it feels like to have a cervicogenic headache. Fortunately, a physical therapist may be able to provide relief through manual therapy and mobilization techniques that target tight neck muscles and restore motion. By releasing tension around the head and neck, many physical therapists are able to reduce or eliminate cervicogenic headaches. Most importantly, a physical therapist can address the cause of them and help you prevent them from coming back.

    3. Jaw pain.

    Temporomandibular joint dysfunction, called TMD, is a common cause of jaw pain that often results from poor posture and stress. If you have TMD, a physical therapist with advanced training in TMD can use manual therapy and targeted exercises to relieve pain and other symptoms from TMD, such as dizziness or trouble opening and closing the mouth. They can also help you improve your posture and positioning, especially for work-related activities that often worsen TMD symptoms.

    4. Vertigo.

    If you suffer from a false spinning sensation or dizziness, commonly known as vertigo, a physical therapist may be able to help. Often, vertigo is caused by something called benign paroxysmal positional vertigo (BPPV) which occurs when tiny calcium particles are dislodged in the inner ear. A physical therapist with specialized training in vestibular therapy can easily diagnose and correct BPPV using the Dix-Hallpike test and the canalith repositioning maneuver (CRM). This generally corrects the positioning, relieving vertigo and associated symptoms, such as nausea and pain.

    5. Balance issues.

    Watching people fall on “America’s Funniest Home Videos” may be cause for laughter, but the reality is that falls can be serious, especially as we age. That’s why physical therapy can play an important role in helping improve your balance and reduce your chances of fall-related injury. Whether you’re recovering from a stroke or taking preventative measures against falling, you may benefit from a fun, interactive balance program that will minimize your risk of falling and help you build confidence in your ability to move around safely.

    6. Rehabilitation after heart disease.

    If you’ve survived a heart attack or your heart has been weakened from coronary artery disease, cardiac rehabilitation is a critical part of recovery and getting you back to the activities you enjoy. During cardiac rehabilitation, you’ll work with a physical therapist to strengthen your heart, improve your cardiovascular fitness, and return to a high quality of life. Your plan will be tailored to your unique needs and goals so that when physical therapy is over, you’re prepared and motivated to maintain your healthy lifestyle.

    7. Arthritis.

    When you find that you’re having a harder time doing things you used to because of a loss of function or pain caused by arthritis, a physical therapist can help your body to get moving again. By strengthening the muscles surrounding the joints affected by arthritis, physical therapy can increase your mobility and strength, which improves your ability to participate in daily activities with fewer limits.

    8. General pain.

    If you’re living with body aches, especially before and after movement, a physical therapist may help you get moving again with less pain. Some people think that pain is normal as you age, but a physical therapist can help to relieve and maybe even eliminate your pain. Whether your knees hurt after squatting or you have lower back pain, physical therapy can help you regain strength and restore range of motion in the muscles affected by your pain. A trained physical therapist can also help retrain how you move to minimize pain in the future.

    Do you need physical therapy?

    If you could benefit from physical therapy, here’s what you need to know before you make an appointment.

    • Insurance coverage. In many cases, physical therapy is covered by major insurance plans. During COVID-19, most insurance providers are covering video visits for physical therapy. MedStar Health Physical Therapy can help you determine your coverage options.
    • Physician referral. Some insurance providers require a physician referral for physical therapy. If you do not have one, we are happy to arrange a convenient video visit with a MedStar Health physician specialist, at no cost to you.
    • Decide on your goals. A physical therapist will help you determine what your goals are but it’s helpful to prepare ahead of time so that they can design a PT program that helps you get where you want to be.
    • Find the right physical therapist. Not all physical therapists are trained to treat every condition, so it’s important to find one who has specialized education and experience in an area related to your needs. MedStar Health will pair you up with a therapist who specializes in the care you need.

    In need of physical therapy? MedStar Health is here to help.

    MedStar Health Physical Therapy Locations

    MedStar Health Video Visits

  • May 01, 2020

    By MedStar Health

    Join MedStar Health in recognizing the work of our nurses during National Nurses Week, from May 6 to 12, 2020. As our nurses continue to care for patients in the new world with COVID-19, MedStar Health will be featuring some of our nurses’ stories on our social media accounts, as a way to highlight their above-and-beyond care and show our gratitude. Stories will be shared from all over the MedStar Health system.

    Because one week is not enough, the American Nurses Association will celebrate nurses for the entire month of May. In honor of the 200th anniversary of Florence Nightingale’s birthday, commonly considered the founder of modern nursing research, the World Health Organization has declared 2020 the International Year of the Nurse and Midwife. We want to celebrate and thank nurses throughout our system for their commitment to patient and associate care and wellness.

    Joan K. Bardsley, MBA, RN, assistant vice president at MHRI, serves as MHRI’s representative to MedStar’s Chief Nursing Council and the Nursing Research Council. Ms. Bardsley says, “Nursing needs are met from multiple perspectives. Our MHRI nurses have shown incredible flexibility and tenacity to ensure our research participants are safe. Our nurses are supporting COVID-19 projects that will help us learn more about this pandemic in the future. In addition, many have volunteered for projects to call associates with testing results and advising on follow up. It is gratifying that so many are having the opportunity to learn about what our nurses do in general and how they contribute to research.”

    During National Nurses Week, we would like to extend a special thanks to all our clinical research nurses, and all nurses in the MedStar Health system, as they continue to provide the highest level of quality care to our patients. They are critical in helping provide the best care to our community and are dedicated to advancing health. We appreciate you for what you do.

  • April 30, 2020

    By Ethan A. Booker, MD, FACEP

    Staying at home has made getting medical attention more complicated. Both patients and doctors are under pressure, and appointment scheduling is a challenge. Many people can’t visit the hospital or their doctor’s office due to concerns about coronavirus.

    But there’s been a big game-changer during the pandemic: Telehealth. Using interactive video technology connects patients, doctors and other providers as if they were in the same room. It gives healthcare professionals an effective way to care for patients real-time, while limiting any risk of exposure. When patients and doctors meet by video, many routine issues and concerns can be addressed easily right on-screen. Today, that’s helping thousands of people access the care and expertise they need with peace of mind.

    MedStar Washington Hospital Center is using video communications to give patients convenient access and increase efficiency across the Hospital Center.

    • MedStar eVisit is the remote version of visiting an urgent care center for a non-emergency illness or injury. Doctors and other staff MedStar eVisit around the clock, providing direct care and advising patients when an in-person visit is needed.
    • MedStar Video Visit connects doctors and patients by appointment. This is a remote office visit, useful for staying connected on long-term medical conditions and follow-up care after procedures, as well as routine medical needs. MedStar Video Visit is available according to the provider’s schedule, just like office hours.
    • MedStar eConsult connects both providers and patients throughout the Hospital Center, typically for inpatient care. Through eConsult, doctors can tap the resources of other doctors if a specialty consultation is needed. It also puts those clinical resources at the fingertips of nurses, emergency department doctors and long-term care providers. This effective infrastructure increases patient access to high-level care, saves time for patients and the medical team, and helps us allocate resources more efficiently than ever.

    For most patients seeking medical attention from home, a visit can be done via any device equipped with a camera. While many use their phones, our system accommodates visits from tablets, laptops or desktop computers as well. A smartphone is particularly convenient because its camera can be easily moved around the environment and, in many cases, doesn’t require WiFi and Internet.

    Connect with our medical professionals without leaving home. Telehealth is your 24/7 virtual link to MedStar Health. Dr. Ethan Booker has more. https://bit.ly/2SmekoA via @MedStarWHC @E_BookerMD

    Click to Tweet

    The Power of Video

    The great connector here is video technology. Even without the aspect of physical touch, an experienced healthcare provider can learn a great deal from a video session alone.

    For example, if coronavirus symptoms are suspected, the healthcare professional will look for labored breathing, noting how the patient moves and any difficulty in speaking. To refine the assessment, we might ask a patient to hold their breath or count to 30 quickly. We can instruct them to take their own pulse, check their temperature with a home thermometer or demonstrate an exam finding.

    It’s not unusual for family members and others living with the patient to be involved in these visits as well. At a time when hospital visits are curtailed, video lets family and friends accompany their loved one during the session. This can boost morale, as well as help the patient remember and comply with the doctor’s orders.

    For more routine issues, the camera is a powerful tool. We can assess the condition of the skin and look closely at growths or rashes; assess the eyes and eye movement; check for inflammation in the throat; or have the patient stand, sit, walk, bear weight on a joint or change position to assess muscle pain, strain or orthopedic injury. Skin tone also tells a story and we can make accurate assessments of neurological and psychological health. We ask all the right questions to help gauge symptoms and narrow down potential causes. And we can tell very quickly if the patient needs in-person attention—and, if so, help with necessary arrangements.

    All the confidentiality rules and regulations associated with traditional care are in effect. We follow established guidelines to ensure each patient is in a private setting where health information cannot be accidentally compromised. It’s also the reason we use our own highly secure system, without relying on outside videoconferencing services or social media.

    A video visit may also enable us to assess the home environment: Is it safe? Do you have the supplies you need? Who else is there to help you if you’re ill? The patient can even point the camera at their medicine vials so we can accurately record prescription medications and dosages. Assessing someone in the office may be less useful in some situations than seeing how a patient navigates their home. Can you climb the stairs? Can we talk about some ways to reduce fall risk? For much of the history of medicine, care was delivered in the home. Technology allows an opportunity to return to that traditional practice.

    Technology and Social Distancing

    Telehealth was taking baby steps before the COVID-19 pandemic. When public officials embraced social distancing and staying at home, its use exploded worldwide.

    In February 2020, there were about 240 total patient encounters for MedStar eVisit and Video Visits, but the health system had invested in the infrastructure and knowledge to operationalize at considerable scale. From the early phases of the pandemic and social distancing, MedStar eVisit provided a valuable conduit of care to our patients, without the need for them to leave the comfort of their homes.

    Consider this: The average patient comes in contact with five-to-seven healthcare workers during an in-person visit, as well as other patients in the waiting area. So, eVisit was able to have a significant impact during the current crisis. In the first month of social distancing alone, we provided 11,000 eVisit sessions. Of that total, 85 percent of the patients were handled effectively by video. That’s 8,000 encounters that previously might have required a visit to a medical facility, handled with zero personal exposures.

    MedStar Video Visit also experienced a big increase in visitors. In the first three weeks of stay-at-home recommendations, we logged 24,000 visits—as many as 3,000 in a single day. These were largely dedicated to ongoing, routine care for diabetes, cardiac conditions, hypertension, and follow-up after procedures. Again, the impact in limiting exposure cannot be overstated and will play a significant role in flattening the curve of infection and easing the burden on the healthcare system.

    Streamlining In-Person Visits as Well

    It’s hard to be in more than one place at a time. But technology makes it almost possible. Since 2016 the Hospital Center has been at the forefront of a process to improve throughput in the emergency department with a remote-enabled physician being available at dozens of places at once. In addition to the triage area of the ED, the physician is providing consults to urgent cares nearby to facilitate movement to the ED or potentially avoid it all together. The COVID-19 crisis greatly expanded this program which now provides triage and the Evaluate-Treat-Discharge (ETD) workflow at 8 emergency departments. ETD allows a physician to remotely evaluate a patient in collaboration with the in-person nurse and, if appropriate, discharge them without further time in the ED or contact with other patients or health care workers. This limits interactions, protecting patients and the medical team from exposure to illness. It puts qualified crisis care consultation wherever we need it. It reduces consumption of gowns, masks and other personal protective equipment, all in short supply. And it dramatically reduces the time it takes to treat and release patients who don’t need hospitalization—56 minutes in one trial, compared to two and half to three hours under normal circumstances. Each patient could interact with just two people in person, a registration service associate and a triage nurse, compared to an average of seven before.

    The emergency consultative role is expanded too, with our ED physicians available to help all 14 MedStar Health Urgent Cares and the MedStar Visiting Nurse Association in the field, as well as MedStar National Rehabilitation Hospital inpatient units.

    Healthcare providers are at constant risk of exposure. Without telemedicine, any provider who tests positive would be taken out of circulation to quarantine at home. With it, these providers continue to make a positive impact, using their invaluable knowledge, skill and experience to help others remotely—even as they self-isolate.

    In the MedStar Washington Hospital Center critical care areas, technology is being used to allow critical care rounding, ensuring care to our sickest patients while preserving PPE, and our Hospital Center specialists are using it to provide consultative guidance to other critical care providers throughout the system. In those same units, interactive tools are used to allow patients to connect to family members who are unable to visit in the current crisis.

    Communication with a patient on a ventilator is very limited. Because the pandemic has restricted visitation, technology is keeping lines of communication open between the team and family. This can be critical when questions arise around extreme measures or do-not-resuscitate orders or to honor patient and family wishes in hospice or palliative care.

    The Future

    This pandemic has changed healthcare delivery significantly and permanently. I do not see us going back to the way things were, once social distancing and isolation orders are lifted. Interactive capability is limiting travel, wait times and infection exposure. Now that so many have experienced the benefits, it will likely remain a prominent mode of delivering patient care.

    Telehealth has been a promise of the future for more than a decade, with suggestions for many years that its time was just around the corner. The present time is demonstrating the safety, quality and efficiency of the care delivery, while supporting the public health need to stay home. With the experience of the present, the next expansion will be to deliver better, quicker specialist access to patients, to connect more data of the patient’s daily life to the care journey, and to create a community of caregivers around a patient who can share that data and quickly and seamlessly coalesce around an issue to help. Patients will want easier, quicker, and less structured access to their doctors. And doctors will want access to their peers, the data they need to provide the best care and the ability to serve their patients’ needs while meeting their own life goals.

    Telehealth has features that are different than being in-person, and it’s important to be thoughtful about what is different and what is possible. With the right mix of interactive tools, we can deliver efficient, cost effective care at the highest quality and with the patient as the central focus for better health and wellness. It is an exciting time to be part of it.

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