Since the launch of the COVID Confirmed (COCO) Clinic in early April, over 4,700 patients with COVID-19 have been given virtual follow-up services after being discharged from the hospital. Not only has this virtual outpatient clinic helped patients on their road to full recovery and often kept them from being readmitted to the hospital, it also provided resident physicians and senior medical, nurse practitioner, physician assistant, PharmD, social work and behavioral health students, with a place to complete their clinical rotations. In mid-March, the Association of American Medical Colleges (AAMC) issued new guidance for medical student clinical rotations during the coronavirus which stated that it, “strongly supports medical schools pausing all student clinical rotations, effective immediately, until at least March 31,” due to concerns about the availability of personal protective equipment (PPE) and to give time for appropriate educational strategies and alternative clinical experiences to be developed and implemented.

Volunteers and trainees played vital roles within the clinic which included conducting regular welfare checks, offering support and discussing any symptoms that haven’t been resolved. Social work and behavioral health students were not originally part of the COCO Clinic when it first launched, but the team quickly realized that COVID-19 and quarantine could severely impact a patient’s mental health and so the interprofessional team expanded. The medical, social, and mental health assessments screened for depression, anxiety and substance abuse, and if a patient answered “yes” to any of the questions, they were offered resources or referrals to support. According to Asa Oxner, MD, FACP, COCO Clinic operations director, one patient agreed to being referred to the mental health team of COCO and a real suicide attempt was mitigated.

In addition to regular follow-up assessments, nurse practitioner students were in charge of monitoring the dashboard that displays the oxygen levels and heart rates of high-risk patients who were wearing a special device on their wrist.

A patient wearing one of the COCO Clinic’s monitors. Photo by CBS affiliate, 10 Tampa Bay, from their, “COVID-19 Telehealth Clinic Getting Overloaded with Tampa Bay Patients” video.

“Volunteering with the clinic has been a unique educational experience. The clinic administrators do a great job of turning every opportunity into a teaching moment,” said Joshua Mizels, Morsani College of Medicine fourth-year medical student and past clinic volunteer. “My classmates who all volunteer have had the opportunity to keep interacting with patients, giving us the opportunity to learn more about what they are going through during this pandemic.  The experience from this opportunity has been invaluable toward my medical education. ”

Lucy Guerra, MD, MPH, FACP, and Asa Oxner, MD, FACP, co-coordinators of the COCO Clinic, along with Elimarys Perez-Colon, MD, medical director, Christine Jennings, RN, nurse manager, and Rachelle Idziak, MD, data manager, led the effort to get the clinic up and running and play a pivotal role in helping the community. For their dedicated efforts, the doctors received a USF Health Culture Coin from Chief Medical Officer, Dr. Mark Mosely.

Dr. Asa Oxner (left) and Lucy Guerra (right), COCO Clinic co-coordinators, were presented with USF Health culture coins by Dr. Mark Moseley, USF Health chief medical officer, for leading efforts to get the virtual clinic up and running.

“We have been successful in offering close follow up to patients keeping them out of the hospital when able, monitor patient’s vital signs remotely to identify patients at higher risk, safely linking patients to care and offering education and reassurance to patients with COVID19 in the Hillsborough county,” said Dr. Elimarys Perez-Colon, assistant professor of medicine, vice chief of medicine at Tampa General Hospital, and medical director of the COVID-19 Confirmed Clinic. “The data collected will assist our department of health to better understand the distribution and epidemiology of COVID19 in our county. This effort wouldn’t have been successful without the assistance and compassionate care offered by our trainees.” In the first three months, over 150 trainees played a part in the care of patients.

The COCO Clinic has been the talk of the town, featured in news stories by ABC Action News, Baynews 9, 10 Tampa Bay, among others.

After the success of the virtual clinic for COVID-19 patients, clinic leaders began working with partners at Tampa General Hospital and the Florida Department of Health to make the clinic a permanent resource for the community. As of November 12th, the COCO Clinic transitioned management of the clinic to TGH and became the TGH Transitional Care Center. “This transition will allow the clinic to continue operating and provide excellent care to our patients impacted by COVID-19, while allowing USF Quality and Clinical Operations Department staff who have been assisting the COCO clinic to return to their normal non-COVID duties,” said Dr. Moseley. “The clinic will continue to provide hours to our medical, pharmacy, and nurse practitioner students and our teaching attendings will continue to support the clinic. TGH has also been able to hire several RNs and Mas, who have been training in the current clinic and will be able to facilitate a smooth transition.” An emphasis will be put on taking care of COVID-19 ‘long haulers,’ virus survivors who continue to have side effects weeks, or months, after surviving the coronavirus. Caring for these patients will also help conduct research into the little known long term effects of COVID-19. Beyond COVID-19, the clinic can continue to help patients using the same monitoring and staffing model, but for serious chronic diseases such as heart failure or chronic obstructive pulmonary disease (COPD).

As COVID-19 forced the closing of many health care practices, USF Health quickly shifted gears in March to convert patient appointments from in-person to telehealth.

Since then, patients have stayed connected with our health care teams and perhaps reaped other benefits, as well.

Here’s an interesting look at the data:

In total, from March 18 to Sept. 14, 2020, USF Health completed 80,961 telehealth appointments from clinics within our multiple locations throughout the region. To streamline the estimation on travel, we counted them as appointments in one of our flagship facilities – Morsani Center for Advanced Healthcare or South Tampa Center for Advanced Healthcare – thus we provided 67,850 completed telehealth appointments.

In addition, we simplified the distance travels by using geocoded addresses that followed longitudinal/latitudinal lines (as the crow flies), vs a typical road map. Then we multiplied by two to reflect a round trip.

The results: for the 67,850 completed telehealth appointments that replaced traveling to either the Morsani Center or STC, our patients saved the equivalent of:

• Total round-trip mileage saved: 2,548,724
• Gallons of gas saved: 114,293
  • Based on 2017 EPA fleet average of 22.3 mpg
• $ of gas saved: $233,157
  • Based on FL average cost per gallon between March – August of $2.04 (EIA)
• Greenhouse gas CO₂ saved equivalencies:

• • CO₂ saved (lbs): 2,239,283
  • CO₂ saved (tons): 1,120

• Equivalent of removing 219 passenger cars from the road for one year

Drawing on the expertise of regional physicians, including experts from USF Health, U.S. Rep. Ross Spano recently hosted a discussion about the impact telehealth could have during the current COVID-19 pandemic.

U.S. Rep. Ross Spano (FL-15) hosted a roundtable discussion at USF Health’s Morsani College of Medicine downtown Tampa June 2, with medical professionals, including USF Health doctors, on how COVID-19 has changed telehealth. From left, Dr. Mark Moseley, Dr. Nishit Patel, Dr. Eva Crooke, Rep. Ross Spano, Dr. Charles Lockwood and Dr. Chris Pittman.

Called How Telemedicine Can Help w/COVID-19, the roundtable conversation was held June 2 in the newly opened USF Health Morsani College of Medicine and Heart Institute in downtown Tampa.

The event offered an exchange of ideas for how telehealth is impacting patient care during the current COVID-19 pandemic and while patients follow stay-at-home guidelines, and telehealth’s place in future health care offerings once COVID-19 dies down or there is a vaccine.

The physicians represented a range of specialties, offering a better sense for the areas of health care that could make the best use out of telehealth.

Roundtable participants included:

• Eva Crooke, MD, the Women’s Group. Her specialty is obstetrics and gynecology.
• Charles J. Lockwood, MD, MHCM, senior vice president for USF Health and dean of the Morsani College of Medicine. His specialties are obstetrics and gynecology and maternal-fetal medicine.
• Mark G. Moseley, MD, MHA, CPE, chief clinical officer for USF Health. His specialty is emergency medicine.
• Nishit Patel, MD, FAAD, associate professor and chief medical information officer. His specialty is dermatology.
• Chris Pittman, MD, Vein 911. His specialties are radiology, and venous and lymphatic medicine.
• S. Rep. Ross Spano, Representative of the 15th District since 2019.

What they said…

Dr. Charles Lockwood: “We’ve learned a lot about its limitations and a lot about its potential… It needs to stay because I think it has a place.” On the downside of telehealth: “There’s always the risk of missing something. We depend so much on clues that are often very hard to define. Might be the expression on a patient’s face, it might be a physical exam finding. So you miss that, literally, that physical contact…It’s up to the physician to understand the limits of the technology.”

Dr. Mark Moseley: “One of the things I think is a concern is that it doesn’t apply equally to all specialties. For a practice like psychiatry it works really well. In fact, I think they’re seeing more patients now through telehealth than what they did before. Some specialties like dermatology or ophthalmology, where it’s a highly specialized field or there are parts of the physical exam that require special equipment, just aren’t quite as good. So, it gets to the issue of use cases and if you pick a good use case for the technology the technology enables you to do that. If you pick a poor use case, then that clearly is a risk. Because you might assume you’re able to do everything but you can’t… We’ve learned a lot during that period of time (since telehealth) and some of it is learning what we can and can’t do. And realizing you’re going to have to pick the right use for it. It’s a tool for us, no different than a stethoscope or something we have in our specialties. But if we use the tool incorrectly, that’s when the risk comes in.”

Dr. Nishit Patel: “For dermatologists, one of the things that we do a lot of is skin cancer monitoring for melanomas and for other things. That’s one of the things that, in order to do a really good job, you have to get high-quality photos, and use a special magnifying lens to look at it… Some guidelines exist but with the whole country moving so quickly to telehealth, we’re going to get a lot of good literature out of this to try and expand on what are the appropriate diagnoses and appropriate cases (for telehealth). And the other thing that really important to mitigate some of that potential risk is being able to have the fluid situation between seeing a patient in telehealth and if you need to see them in person. If you already have that existing relationship, you can say why don’t we have you come in …Having that existing relationship for not only telehealth visits but also with a continuum to in-person care.”

Dr. Eva Crooke: “It will definitely not replace what we do in the office. It’s a good adjunct where we can utilize it in addition. It definitely makes for a lot better efficiency. We noticed that as probably the biggest piece in our practice where we can see more patients, they’re satisfaction rates on wait times, without any other piece of their satisfaction scores, is a huge difference. So I think it will be used as a tool intertwined into the way we practice right now, assuming we can keep the barriers minimal.”

Dr. Charles Lockwood provided Rep. Ross Spano with a tour of the new building, which opened in January 2020.

Photos by Allison Long, USF Health Communications.