How Does Tele-ID Inpatient Care Compare to In-Person Care? Results from a Tertiary Academic Medical Center

Remote telemedicine ID consults (Tele-ID) are effective for community hospital inpatients. Tele-ID is not used at academic medical centers (AMCs) as onsite ID physicians are often available. During the COVID-19 pandemic, intra-hospital Tele-ID was implemented to conserve PPE and reduce SARS-CoV-2 exposure. In this study, we compared outcomes of Tele-ID to in-person ID.

A longitudinal, matched, case-control study was conducted at three Pittsburgh tertiary AMCs. Cases were evaluated via Tele-ID (video, e-consults, and telephonic consults) between 3/1/20 and 5/31/20. In-person consults between 3/1/19 and 11/30/19 were matched by demographics, transplant status, comorbidity indices, and ID-specific diagnoses. Both groups were evaluated by general ID (GID) or transplant ID (TID) physicians. Patients with COVID-19 were excluded. Outcomes included in-hospital, and 30-day mortality, 30-day readmission, intensive care unit (ICU) admission, and ICU length of stay (LOS).

Among the Tele-ID group, 125 inpatients were evaluated by GID and 81 by TID. The majority were Caucasian, male, and non-ICU. A broad range of ID diagnoses were made, most commonly bacteremia and pneumonia. 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. 173 cases were matched to 966 controls by ID diagnosis. Rates of 30-day readmission, ICU admission, in-hospital and 30-day mortality were similar between groups. ICU LOS was shorter in the Tele-ID group (70 vs. 386 h; p = 0.006), although this study was not powered for ICU LOS.

During the pandemic, intra-hospital Tele-ID was an effective alternative to in-person ID consults at large AMCs, with shorter ICU LOS and similar 30-day readmission, ICU admission, in-hospital and 30-day mortality, and suggests that Tele-ID can be used at AMCs safely and effectively in non-pandemic settings.