Multidisciplinary Prenatal Consultation during the COVID-19 Pandemic: A Preferred Model for Many Providers

Abstract

Purpose: Comprehensive fetal care centers address congenital anomalies by first performing advanced fetal imaging (e g ultrasound, echocardiography, fetal magnetic resonance imaging (MRI)) and later discussing those findings, the prognosis, pregnancy management, need for fetal intervention, delivery plan and postnatal management in a multi-disciplinary format This team approach to counseling can be logistically challenging due to the difficulty in assembling multiple providers from varied specialties on short notice To reduce exposure during the COVID-19 pandemic, the Centers for Medicare & Medicaid Services (CMS) broadened access to telehealth services We assessed provider satisfaction with the rapid transition from in-person prenatal visits to multidisciplinary consultations via telehealth as an adaptive response to the pandemic Methods: Patients who were referred to a busy fetal care center during the first six weeks of the pandemic were connected to the appropriate pediatric subspecialists by videoconference Some patients underwent advanced fetal imaging and a telehealth consultation with radiology and other appropriate subspecialists took place immediately after imaging was complete In other instances, imaging occurred and a telehealth visit with all applicable subspecialties took place in the patient's home at a later time During multidisciplinary meetings, the images were reviewed with all participants via screen sharing In some cases, providers met to review images prior to admitting the patient to the video call Provider type is listed in Table 1 Provider satisfaction with the telehealth paradigm was assessed by convenience sampling using an electronic survey Results: 22 surveys were administered and 18 providers responded for a response rate of 82% Table 2 shows the overall satisfaction with connectivity and with the format compared to in-person visits 89% of providers were highly satisfied with the telehealth format 72% of providers would prefer the multidisciplinary telehealth format to an in-person visit for future visits after COVID-19 restrictions are lifted 22% of providers would leave the choice to the patient's family One provider preferred in-person visits Other providers stated that they find inperson visits better for comforting the patient and for the ability to draw pictures or show educational materials Conclusion: Providers were overwhelmingly in support of multidisciplinary telehealth conferences for prenatal consultations This study shows that a multidisciplinary telehealth visit can be done with a high degree of satisfaction for providers Specific benefits included the ability to review images together as a team, to review the delivery plan and to provide care coordination across specialties Further studies are needed to better analyze the multidisciplinary approach to telehealth visits for prenatal care