Three nurse practitioners reflect on the impact of CincyKids Health Connect on care delivery

It has been one year since the launch of CincyKids Health Connect, a 24/7, no-appointment-necessary, pediatric video visit service—an offering from our Emergency Medicine team that arrived just in time for the public to shelter in place. For some staff, as you might imagine, it was just what the doctor ordered. For other clinicians, it meant readjusting their tried-and-true, decades-long practices and bending to the changing demands. Three of our longtime Emergency Medicine nurse practitioners (NPs) have been there since Day 1 and can now add “telehealth practitioner” to their CV.

Allison Schwandner, MS, APRN, has worked in the Emergency Department (ED) for 11 years, and as a nurse practitioner with Emergency Medicine for 4 years. Michelle Widecan, DNP, APRN, clinical manager, has worked at Cincinnati Children’s for more than 28 years. Ebony Moorefield, NNP, started at the medical center in 2013, transferring to the ED in 2015. Schwandner, Widecan and Moorefield took a moment to reflect on the impact CincyKids Health Connect has had on their practice and the ways in which they have seen the delivery model change.

Since the launch of CincyKids Health Connect, which was almost one year ago, how have you seen healthcare delivery change? AS: The three most important changes have been access to care, convenience and use of video technology. MW: About two months after we launched CincyKids, the COVID pandemic began, and we slowly started to see telehealth really take off across the organization, locally and beyond. EM: I think it has been easier to provide care for those patients and families who don't necessarily need to be seen in person. The opportunity to provide education and guidance to families has been key. Families are pleasantly surprised to have care delivered by a healthcare provider whose judgment they can trust. It also helps us assist parents in getting them care where the care is needed. Sometimes telehealth is not the most appropriate place for care. With education, the parents are on board with our decision to recommend in-person care. How have you noticed a change in healthcare delivery over time? AS: Over the past 11 years, working in the same division and department, I have noticed the number-one change in healthcare delivery has been the focus of patient and family experience. The convenience and speed is a big satisfier of patients and families. We have developed a system in which we focus on shortening the wait time to see a provider. And now, with telehealth, it reaches outside the hospital walls, where they can get immediate care by highly trained professionals within minutes. MW: We have made many advances in healthcare, but the change I notice is related to insurance coverage for families. Whether they have good coverage, any coverage or high deductible plans, they are looking for ways to get sufficient care while paying the least amount (if they are self-pay or have high-deductible plans). EM: I have been in healthcare for a long time. I have seen care transition from total physician-led care to the involvement of nurse practitioners in almost all areas of medicine. I have seen the transition of healthcare from generalized to more sub-specialty care. Patients receive care in a number of venues, from doctor's offices to pharmacies and supermarkets. In what ways has it remained the same over the years? AS: At Cincinnati Children’s, we have always strived to provide the highest level of care to all patients. MW: In Cincinnati, most families who need care for their children continue to gravitate to the services we offer at Cincinnati Children’s. EM: I think the care we provide has remained the same. How did you feel about telehealth before using it? AS: I was skeptical. I couldn't wrap my head around assessing a patient over a video and not laying my hands on them. MW: I’ll be honest. I was very nervous about this offering. I like to see my patients face-to-face. I wasn’t sure how this would really work for the offering/service line we had been asked to be a part of. EM: I have to admit that I was not thrilled about providing care via Telehealth. I love face-to-face encounters. I did not feel that I would have the same level of gratification in telehealth. I also did not feel that I would be as effective. Has your opinion changed? If so, why? AS: My opinion has completely changed. I do feel like there is a learning curve to getting used to doing video visits and what you are comfortable seeing and treating. However, with the list of symptoms that we see—minor illnesses and injuries—it’s a new way to reach more people from the safety and comfort of their home, which is especially important and helpful during this year’s pandemic. MW: Yes, I do enjoy it and find we have been able to offer a service to a subset of patients that can benefit from our service and not need to go in for an in-person visit. We can also help families who really need to go for an in-person visit get to the right place. There are times when patients/families arrive to the ED and could have gone to Urgent Care, which saves cost, but then when patients/families arrive at the Urgent Care and they really should have been seen in the ED, it can delay the care they truly need. We have helped guide them to arrive at the best place of care at one of our locations or with their primary care physician. EM: I love telehealth. I have found satisfaction knowing that not all children require in-person visits in order to deliver quality care. Delivering high quality care is on us. It is our job to provide the best care no matter where it's delivered. I also feel that caring for children in the home lends a different perspective because some of the barriers are gone. For example, children are happy at home. While I cannot hear their heart beat, feel a belly or touch a patient, I do feel that there are ways to identify those patients whose care can be managed via telehealth and those requiring in-person evaluations.