When COVID Came Calling, Telemedicine Answered

Six infection preventionists crammed into the same limited office space. That didn’t seem like such a good idea to Jody Feigel, RN, MSN, the nurse manager for infection prevention at VA Pittsburgh Healthcare System. She decided to put them on a rotation where three would actually be on site, while the other three would be doing their jobs via telemedicine. “It’s a nice balance,” Feigel tells Infection Control Today®. “Everybody gets a little taste of everything.” Like the rest of us, Feigel doesn’t know just how the coronavirus disease 2019 (COVID-19) is going to play out in the end. She is pretty sure, however, that telemedicine will continue to be an important tool in her arsenal even when the new normal arrives.

Infection Control Today®: Some people might think that telemedicine and infection prevention wouldn’t be a good mix? Have you found that to be the case?

Jody Feigel, RN, MSN: Actually, no. I’ve been very blessed with a very smart group of six infection preventionists, all masters prepared nurses. And while they are on call, they do have their laptops at home and are required to take calls from all throughout the hospital, and then look up patient information and report it. So, we already had that back training in place. Moving toward an office at home just took a little bit of getting used to, but not so bad.

ICT®: What was a major adjustment that you had to make?

Feigel: I think just restricting our hours, because you find when you’re at home, you roll out of bed, you get your coffee, you immediately get on your computer, and you just work. When we’re at the hospital, we have a lot of interruptions and a lot of times they’re good interruptions, sometimes not so much. And we head out to see whatever fires need to be put out. Still, we are continuing with education with the nurses, answering questions for anybody from housekeeping, to maintenance, nursing, anything that we can do to help provide a level of comfort and safety for our staff is pretty much what we do in the hospital. At home, we’re doing all computer work. And if you’re on call, we’re also answering the call phone.

ICT®: You’re writing an article for our Infection Control Today®’s September issue on this topic and I think you write that for some things there’s no substitute for a face-to-face, in-person meeting. Is that an accurate paraphrase?

Feigel: Oh, for sure. Being at the hospital and having those face-to-face conversations and providing face-to-face education is paramount in what we do. So, if somebody is needed to talk to a patient, talk to nursing staff, having those conversations in front of somebody makes it a lot easier than just having a simple phone conversation. People get very distracted over the phone, and email just doesn’t carry the same weight. We do still like to have those face-to-face interactions. Yes, sir.

ICT®: What is the demographic of your VA Pittsburgh Health System? I’m assuming—and tell me if I’m wrong—that it’s older people? Veterans?

Feigel: All veterans, yes, sir. All veterans. We have two campuses. We have a campus in Oakland and then we have a skilled nursing campus at the [H. John Heinz III Department of Veterans Affairs Medical Center]. All of our patients are veterans. We’re very blessed to be able to take care of that patient population for sure.

ICT®: Is it an older population?

Feigel: No, not necessarily. We have vets that are in their 20s that come here for care. And then we also have vets that are you know, World War II, that come to the VA for care. Depending on the patient’s needs. We care for veterans of all ages, all socioeconomic groups. Any vet can come to the VA for care for sure.

ICT®: What were some of the questions that you were getting from fellow staff members when COVID first came?

Feigel: People were very afraid. They had questions about the guidelines. And I can tell you when COVID first started the guidelines changed, it seemed like hourly, sometimes it was daily. So, providing that education on what PPE they needed to wear, how we were going to isolate patients, how is the organism transmitted. All of those were huge concerns for staff because they’re watching the news and comparing the VA to a lot of other facilities. We had to make sure that we emphasized the importance of CDC guidelines, and the World Health Organization and that’s who we’re going to follow when we’re caring for our patients and protecting each other.

ICT®: Here are some yin and yang questions. Was there a moment when you said, “I’m so glad I’m doing this by telemedicine?” And was there a moment when you said, “I wish I wasn’t doing this by telemedicine?”

Feigel: I love being at the hospital. But telemedicine, it does serve a purpose as well. When this all started, we decided very early in the process that with six infection preventionists—they share office space—that we needed to make sure everybody was safe. We decided to rotate three people in and three people out. So, every day of the week, I have three infection preventionists here at the hospital. And then I also have three that are working from home. It’s a nice balance. Everybody gets a little taste of everything.

ICT®: You have six infection preventionists under you?

Feigel: Yes, I have six infection preventionists. And then I also have an administrative assistant.

ICT®: Would environmental services come to you for advice?

Feigel: Yes, environmental services, because they don’t have the level of training that nursing does. They had a lot of questions and a lot of concerns about taking the organisms home to their loved ones. And, you know, we really provide a lot of reassurance that if you’re wearing your PPE correctly, if you’re washing your hands, if you’re practicing social distancing, greater than six feet, then you’re protecting yourself and you’re protecting other people.

ICT®: Have you noticed waves there where you’re at? Has it peeked at one point, gone down, and then peeked again?

Feigel: It has happened, and I think it’s happening everywhere. We’ve been fortunate that we got … our first wave was in April. Then, it kind of quieted down and we noticed peeks and valleys after probably seven to 10 days after each holiday. Easter was our first holiday. It was kind of quiet. Then after Easter hit, the week later, we saw a little spike. Then Mother’s Day came then we saw a little spike on Memorial Day, Father’s Day. Fourth of July really ramped us back up. Also, with the shutdown that helped decrease our numbers, and we plateaued and saw somewhat of a small decrease. But then after the Fourth of July, we’ve seen an increase throughout the state as well as here in Pittsburgh.

ICT®: When things get back to normal, do you see yourself using telemedicine more often than you did in the past? You just said you love being on the ground, you love being at the hospital itself, but can you see yourself integrating telemedcine more into your practice?

Feigel: I think we probably will continue to use it. I can’t think of a downside except for not being face-to-face with people. And I don’t know what our new normal is going to be or when it’s going to happen. I don’t know that we’re going to have a normal until we have a vaccine. Right now, this is our normal. And we are comfortable with what we’re doing. We still feel like we’re providing the highest level of care because we do have such trained and skilled people at the facility. I feel that after things quiet down—or whatever our new normal is after a vaccine—I think we still will be utilizing telemedicine. I think there will still be a place for it for sure.

This interview has been edited for length and clarity.