1001. Comparison of Periodic In-Person ID Care to Daily Tele-ID Care at a Community Hospital


 
 
 Access to ID specialists is absent in most US counties. Remote access to ID specialists via telemedicine is a potential alternative to in-person ID care, although comparative data are lacking. We compared outcomes between periodic in-person and daily remote ID care.
 
 
 
 Retrospective EHR analysis of 200 patients at a 164-bed community hospital, which historically had access to an in-person ID specialist every 3rd day with limited telephonic follow-up. In May of 2020, access to a team of Tele-ID specialists was provided through live audio-visual and e-consults, with telephonic consults after hours and on weekends. Outcomes for 100 consecutive patients cared for by the in-person physician from 01/2019 to 11/2019 were compared to the first 100 patients care for via Tele-ID from 05/2020 to 08/2020.
 
 
 
 Of the 100 patients seen via Tele-ID, 73 were live initial consults and 27 initial e-consults. These 100 consults occurred over 4 months compared with 11 months for the 100 in-person ID consults, revealing greater utilization. Most patients were Caucasian, male, and >60 years old (Table 1). Tele-ID patients had significantly higher Charlson Comorbidity Index (CCI) scores (5.3 vs 4.5, p=0.047), shorter LOS (7.5 vs 9.08 days, p=0.003), less frequent discharge on IV antibiotics (34% vs 51%, p=0.007), and more frequent discharge on PO antibiotics (39% vs 23%, p=0.014; Table 2). There were no significant differences in the frequency of transfer to tertiary care (13% vs 14%, p=0.84) or in-hospital mortality (2% vs 2%). The 30-day readmission rate was higher for Tele-ID (11% vs 1%, p< 0.01); however, only one readmission was ID-related (a new C.difficile). The diversity of ID diagnoses made was not different (Figure 1). Table 1.Patient DemographicsTable 2.OutcomesFigure 1.Diagnoses
 
 
 
 A Tele-ID service with daily availability increased utilization of ID care at a community hospital. Despite higher CCI scores in Tele-ID patients, LOS was shorter and discharge on IV antibiotics was less frequent compared with the In-person service with no difference in ID related readmissions or in-house mortality. These findings support remote Tele-ID care as a solution where access to ID expertise is limited.
 
 
 
 John W. Mellors, MD, Abound Bio: Multiple|Abound Bio: Ownership Interest|Gilead Sciences: Advisor/Consultant|Infectious Disease Connect: Advisor/Consultant|Infectious Disease Connect: Ownership Interest Rima Abdel-Massih, MD, Infectious Disease Connect: Co founder and Chief Medical Officer|Infectious Disease Connect: Ownership Interest.
