On-Demand, Virtual Health Care During COVID-19: Clinician Redeployment and Telemedicine Utilization in a Children's Health System

Background: The COVID-19 global pandemic inspired an unprecedented surge in virtual health care. Safety precautions limited in-person urgent care options, despite high patient demand. This study describes how one children's health system redeployed clinical health professionals to expand existing pediatric, urgent care, on-demand telemedicine in the early months of the United States' pandemic response. Patient utilization and visit characteristics during the pandemic are contextualized relative to pre-pandemic, business-as-usual (BAU) operations. Materials and Methods: This IRB-approved study is a descriptive, retrospective analysis. Key elements of the clinician redeployment process and shift in physician workflow are described. Retrospective data analysis included routine patient and visit characteristics for urgent care, on-demand telemedicine services received January to May 2020. BAU represented telemedicine encounters between January and May 2019. Results: Twenty-eight redeployed pediatricians and advanced practice registered nurses were trained and credentialed to assist the on-demand pediatrician team on the existing telemedicine platform. During 2020, providers completed 5,055 telemedicine visits, a 168% increase over the same timeframe in 2019. Pre-pandemic visit wait time was 6.29 +/- 5.4 min, which increased to 23.25 +/- 34.30 min during 2020. Top chief complaints included skin-related concerns (27.9%) and upper respiratory infections (20.2%) and were consistent across years. Patient satisfaction with provider and platform were high. Discussion: By engaging and training redeployed clinicians during the pandemic response, health care access was maintained for thousands of patients. Conclusion: Where regulations allow, clinical health professionals can be trained and redeployed rapidly to on-demand telemedicine platforms to successfully meet spontaneous increases in demand for virtual care.