The crisis gave us the opportunity to update some long-overdue changes to the way neurologists care for patients in the 21st century, which were already lurking beneath the surface. Proposals for process changes to patient workflow, greater reliance on data analytics, and the brave new world of telemedicine would occasionally surface in emails and newsletters. These proposals always seemingly lacked the head of steam required to make them mainstream, rather than anecdotal tools to help care for patients with stroke or MS complications, that come in and out of a large academic hospital.
Then COVID-19 spreads across the globe. Patients are concerned about coming to the hospital. Providers are concerned about who might be infected and how to manage exposure in the clinic. Patients with neurologic disease are precisely the group that needs to be protected from a highly infectious and potentially lethal viral infection, as they are commonly older, often with comorbidities that make an infection more dangerous. Yet, chronic diseases continue to flare up despite COVID-19 and strokes continue to strike at inopportune times. Inpatient neurology continues to be required to solve medical mysteries and minimize neurologic complications of a variety of diseases including COVID-19.
Since the pandemic took hold across Los Angeles, the state of California, and the world, neurologists who do hospital care having been asking tough questions about their own habits and developing creative solutions. Should we evaluate the nervous system without being in the room? Can we see subtle changes in a neurologic exam, for example of the eyes, if we are not leaning over the patient’s bed? What patients and conditions really require hospitalization? Neurologists are already familiar with the use of telemedicine to bring care to under-served areas, and so were prepared for these changes and the rapid adoption of telemedicine both in the hospital and outside to address many urgent needs amidst the crisis. Rapid adoption of more flexibility and creativity in the software platforms and tools that could be used to reach patients quickly and efficiently have altered the patient care landscape, likely permanently, and have established telemedicine as a valuable tool of all neurologists. More importantly, patients have adapted to telemedicine and been pleased with the encounter. In surveys of our patients, three-quarters are satisfied or very satisfied and would use telemedicine again.
Hospital-based neurologic care will be forever changed by COVID-19. Response times of neurologists will be faster to both the emergency room and neurologic emergencies in hospitalized patients through the use of telemedicine. Rather than a stroke pager, neurologists will carry a mobile device with a direct video connection putting them instantly at the bedside. Digital monitoring of patients for daily clinical check-ins will expand the capabilities of most inpatient neurologists. The incorporation of additional data about neurologic function available from wireless monitors and other wearable devices are sure to become a mainstay of a hospital admission for a neurologic diagnosis. Yet inpatient hospital neurology will face significant challenges in the absence of a rapid return to “normal”. Most critically, how do we continue to educate future neurologists and doctors on the intricacy of the neurologic exam when that exam is executed through a camera? See Dr. Bordelon’s essay below for more on this.