Last year, the cardiac surgery team at Boston Children’s Hospital became the first group within the hospital to log more than 1,000 virtual visits for post-operative follow-up appointments. Barbara Rhodes, physician assistant, and Jacqui O’Brien, clinical research coordinator, have worked closely together to make the Post-operative Telemedicine Program a success. “We schedule our surgical patients for follow up one to two weeks after surgery,” says Rhodes. “Sometimes finding a clinic room for these visits can be difficult given the constraints of space within the hospital. We also realize that follow-up visits can be a hardship on families because of the time and money involved in returning to Longwood.”

Creative benefit for families

Pedro del Nido, MD, chief of Cardiac Surgery, had heard about virtual visits and thought it could work for post-operative appointments and could benefit families by saving them a trip back to the hospital so soon after discharge. This would potentially save them time and money, as many patients require numerous follow-up appointments with their cardiologist, pediatrician and other subspecialties. Rhodes has been caring for patients for more than 20 years, and loves seeing patients after discharge. However, she admits that at first, she was nervous about the virtual PA role. “I was honestly a bit reluctant when Dr. del Nido first suggested the idea to me,” she says. “I was afraid I’d be tense and camera shy, but I’m so comfortable now speaking with my patients and their families using the software. It’s been really great.”

Creating a successful program

The program got its start in January 2017, when Rhodes was teamed up with O’Brien to begin seeing post-operative patients virtually. Together, the two have managed to make the program a success. They now see 80 percent of all post-operative visits virtually. O’Brien says they began by offering the program to local, English-speaking patients, but quickly opened it up to national and international patients, and have expanded language options to include Spanish- and Arabic-speaking patients. In the coming months, they plan to begin offering virtual visits in all languages. “We work with a translation service which is integrated into the virtual visit software,” says O’Brien. “At the start of the appointment, Barbara and the parents can see and speak with the interpreter live on the screen. It’s worked out really well.” Rhodes says that having O’Brien schedule the visits and assist the families with any technical difficulties has been integral to the program’s success. “Jacqui is phenomenal at working with the families,” says Rhodes. “If there’s any discomfort with having a virtual visit or if they encounter technical issues, she patiently coaches them through. She is also good at using her judgement if it seems like a virtual visit won’t be a good fit for a family for any reason.” Once she’s on the call, Rhodes speaks with the family to see how things are going, helps with any questions or concerns, and reviews the post-operative teaching. Virtual visits also allow her to evaluate any incisions. “It’s been a pretty smooth transition from a clinical perspective,” says Rhodes. “It definitely is helpful that I’ve been looking at incisions for many years.”

Building personal connections

She also appreciates the more personal connections she makes with patients and their families. Rhodes believes that virtual visits offer a unique insight into the home environment of patients. “People are just getting back to their routine, and if they’re struggling in any way, I can help with suggestions or reach out to other providers who can assist.” Rhodes explains that because the virtual visits are still a new modality, other clinicians who have implemented the program have arranged to meet and begin to share best practices. “I think it’s a really great modality for many different subspecialties,” says Rhodes. “Telemedicine is a way to make things easier for families.”