Introduction:
The 2019 novel coronavirus disease (COVID-19) was initially identified
in December 2019 in Wuhan, China. Following its spread across the globe
within a matter of months, the World Health Organization classified
COVID-19 as a pandemic.1 Its rapid transmission and
high hospitalization rate have forced health professionals to
drastically alter their practices in order to slow its proliferation.
The rapid influx of COVID-19 related admissions in hospitals around the
United States has led to a widespread shortage of crucial healthcare
resources, particularly personal protective equipment (PPE),
ventilators, and free ICU beds. Surgical procedures further deplete such
resources in a time of acutely high need. Additionally, evidence has
shown that healthcare workers may be particularly susceptible to
infection from the causative pathogen, SARS-CoV-2, with roughly 20% of
exposed professionals becoming infected in Italy.2Following these developments, the Centers for Disease Control and
Prevention (CDC) recommended that all inpatient facilities postpone or
cancel any elective surgeries.3 In the ensuing weeks,
the American College of Surgeons and the American Academy of
Otolaryngology-Head and Neck Surgery followed suit with this
recommendation.4,5
Furthermore, many hospitals and practices have opted to cancel in-person
outpatient clinic visits, where patients oftentimes receive critical
longitudinal care. Like other surgeons, otolaryngologists, and
specifically head and neck surgical oncologists, have been deeply
affected by these drastic measures. It is evident, however, that
physicians must find ways to continue to monitor such patients’
conditions or treat them in some aspect. The popularity and prevalence
of telemedicine has grown rapidly during this pandemic as many
physicians have sought ways to maintain a continuum of care with their
patients.6 Such initiatives have previously been shown
to decrease costs, decrease visit time, and lead to high patient
satisfaction in surgical fields.7,8
Within otolaryngology specifically, certain telehealth assessments have
been shown to allow for quicker examinations without compromising the
communication of crucial information from the patient to the physician,
or vice versa.9 However, the rapid implementation of
telehealth has been a relatively new phenomenon during the COVID-19
pandemic, meaning that physicians oftentimes have to learn how to
optimize their virtual visits to maximize their efficiency and
effectiveness. In otolaryngology, telemedicine has not been routinely
used to evaluate patients, despite estimates that 62% of otolaryngology
patients would be amenable to virtual appointments.10Thus, it may be difficult for physicians to anticipate barriers to their
care during a telehealth visit. Based on the authors’ experience, there
exists a steep learning curve following the onset of such visits due to
a variety of factors on both the patient’s and physician’s side.
To our knowledge, there are no set guidelines or best practices for
patients or head and neck cancer physicians conducting virtual visits.
Drawing upon our experience, we aim to compile a set of guidelines for
physicians and patients alike to navigate telehealth visits during the
era of COVID-19. We also created a handout that can be distributed to
patients prior to the visit, such that patients can familiarize
themselves with general expectations and key examination steps that they
may be asked to perform during the visit.