Jaspal Singh, MD, MHA, MHS, on How I Practice Now: Transitioning Pulmonary and Critical Care Patients to Virtual Visits

In this video, Pulmonology Consultant Advisory Board Member Jaspal Singh, MD, MHA, MHS, from Atrium Health, explains how the COVID-19 pandemic is causing him and his colleagues to rethink how immediate care to the bedside is provided and how health care is delivered.

Additional Resource:

COVID-19 Care360.


Jaspal Singh: COVID-19 is affecting all of us in terms of preparation. Luckily our area hasn't been hit yet, but we're starting to see our first serious cases now in the last week. And we're starting to ramp up our preparations in the last several weeks as to how this is going to affect our patients and our practices.

From a patient perspective, I think many patients are very appropriately concerned. They've been hearing about what patients have gone through in China and Italy. And now they're hearing in the US—with the Seattle experience as well as the New York City outbreaks and most recently New Orleans and also the Detroit area—so that news is making its way out here now in Charlotte. We all respect our patients concerned about not wanting to come to the doctor’s, not wanting to come to the hospitals. We've actually effectively shut down elective procedures for a variety of conditions, and so that's clearly affecting how our patients are taking care of their health. 

The community itself has recently undergone a local warning to stay indoors as much as possible, and so there's been variable levels of enforcement for that. People with chronic lung conditions, specifically, are very nervous about [whether] they have to come to the doctor.

We've actually transitioned our office to having a lot of phone visits. And now virtual visits are coming online, to a point of even having a virtual hospital. In the background, you see I'm actually at home right now, as my home now has a workstation, which can service outpatients for virtual visits. But I can also manage our EIC, which I did last week, just coming off the service now of monitoring our EIC patients from a remote workstation at home. We did that because we felt that we wanted to make the telemedicine services not just useful for this current pandemic, but for any additional future endeavors that we are going to evolve into. Even outpatient medicine—we've talked for years about going virtual or having a telemedicine component—so this is kind of forcing our hand to do so. We're ramping up pretty quickly as a health system, recognizing that patients are still concerned about how to manage things.

For example, for new consultations for sleep medicine, we'll do a lot of them virtually. We started out with phone just to get things going. And now we're going with the virtual visits once we get that entire operation running.

We have a lot of our staff—our nurses who normally help us room patients—helping us manage these virtual appointments, which is a lot of office work and behind-the-scenes, which many of you who are doing it already know. We work with our electronic health record vendors to make sure that this goes as smoothly as possible; that transition is always challenging. 

We work with our hospital colleagues to figure out what can we do with COVID-19 patients, especially. Do we need to go in the room every time? Do we always need to do an examination? Can we do a lot of stuff virtually? We're working through those operations both at the bedside, as well as a system—from our consultants, to our bedside nurses, to our bedside staff—redoing our operations. 

From a bronchoscopy perspective, there's been several society guidelines trying to figure out what to do with these patients. We're appropriately paying attention to all those guidelines, all the body of work that everyone around the world is doing and contributing to to better understand how we can do procedures that need to be done safely, effectively. 

We're fundamentally changing how we approach medicine in general. The more use of technology, less use of visits to do the “usual” visits. More of our staff working remotely so that we've minimized contact. Managing a lot of our patients’ issues over the phone, which is a little bit unique for a lot of us, and especially new for our offices and new for our patients; many of whom have not known anything different are still adjusting to all this. Even though we've been insulated so far from COVID-19, the region is clearly [being affected].

From a critical care perspective, it's dramatic. We've put a lot of investment into doing as much virtual as possible. So that's just rolling out these last few weeks and moving forward as we hopefully don't see a big surge. But if we do, we're working toward preparation, thinking about personal protective equipment—or PPE—just like the rest of the country, making sure that's adequate. [We’re] making sure that we have the right protocols, the processes in place, the cleaning specifications. [We’re] minimizing staff at the bedside, that we really need [who is] there. And when people are at the bedside, [we want to] make sure they have the right equipment, [that they] make the most use of that time in the in the room and make sure that the patient and the staff are both safe. 

COVID-19 essentially is causing us to rethink how we not just provide immediate care at the bedside, but how we deliver health care in general.

Jaspal Singh, MD, MHA, MHS, is a medical director at Atrium Health and a professor for the Carolinas HealthCare System in Charlotte, North Carolina.