360 - Systematic Surveillance of Pediatric Post-Visit Safety and Quality Events for Telehealth vs In-Person Ambulatory Encounters

Poster Number: 360
Publication Number: 360.1993

Background: The rapid adoption of telehealth during the COVID-19 pandemic allowed for new approaches to clinical care in the ambulatory environment. However, the surge in telehealth usage lacked the evidence-based, safety and quality assurance measures that might have been present in non-pandemic circumstances.

Objective: This study assessed 1) 30-day post-visit incident rates and 2) patient and provider experience of virtual and in-person pediatric ambulatory visits via a multi-modal systematic error surveillance methodology.

Design/Methods: We enrolled 910 patients attending virtual or in-person ambulatory clinic visits in Gastroenterology, Orthopedic Surgery, and Urgent Care with a 2:1 virtual-to-in-person ratio. For all patients, a research nurse conducted a 30-day post-visit systematic chart review, noting potential incidents of patient harm, medical errors, and quality concerns. A subset of 452 patients/parents and respective treating providers were invited to complete a survey on experience and perceived safety or quality events. Incidents were reviewed by two physicians who classified events according to level of harm, error occurrence, and type, applying established methodology and definitions. We used Poisson regression to estimate event rates per 100 visits and to compare between visit modality.

Results: We identified 261 incidents among 910 visits (28.7/100 visits), comprising 233 quality concerns (25.6/100 visits), 17 nonharmful errors (1.9/100 visits), and 11 adverse events (1.2/100 visits). Incidents were primarily related to non-medication related therapy or care (n=211, 23.2/100 visits). The incident rate was higher in virtual compared to in-person visits (34.1 vs. 18.3/100 visits, p< 0.0001), driven by differences in the rates of quality concerns (30.1 vs. 17.0/100 visits, p< 0.001) and adverse events (1.8 vs. 0.0/100 visits, p=0.02). Incident rates related to therapy or care, diagnosis, and medication were higher in virtual compared to in-person visits (Table 1). Parents reported high satisfaction with both visit types, with 96% reporting that their concerns were completely addressed during the visit (Table 2). However, telehealth providers were less likely than in-person providers to report achieving all their visit goals (80% vs. 95%, p = 0.003) and feeling extremely comfortable with the diagnosis and management plan (58% vs. 77%, p = 0.01) (Table 3).

Conclusion(s): This study provides insights into the epidemiology of safety and quality incidents in pediatric ambulatory care, with a focus on telehealth. The findings reveal opportunities for enhancing the quality and safety of virtual care.