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Practice Adapts When Patient Visits Plummet

BOTTOM LINE: Pediatricians across the country innovatively optimize care during COVID-19

In short order, pediatricians around the country have learned how to care for children in the COVID-19 world. They have improved the practice of pediatrics in so doing, which the ABP will recognize with MOC credit.

One outstanding example of how much pediatricians are learning and adapting during the pandemic is Redbud Pediatrics in Wichita, KS.

Rebecca Reddy, MD, practices at Redbud with four other board-certified general pediatricians. When Kansas’ governor issued a statewide stay-at-home order on March 16, Dr. Reddy and her colleagues saw patient visits plummet as families — fearful of contagion – canceled appointments.

Like so many pediatricians, Dr. Reddy and her partners knew they had to make some big changes to continue providing high quality care for their patients.

“The key is for us to see the child and the child to see their doctor,” she tells us.

Practice transformation amid a public health crisis had to address everything from patient access and safety to staff communication, staff safety, and practice viability. Personal protective equipment was in short supply. The father of one of Dr. Reddy’s partners, who works in construction, donated his N-95 masks to the practice. He reached out to others in construction who also donated their masks for medical use. Additionally, some families who work in nail salons provided surgical masks they use in their business.

Kally Richardson, Dr. Rebecca Reddy, and Katrina HindsThe masks are critical, she says, because the pediatricians are still seeing newborns, vaccinating children under age 2, treating asthma flare-ups, and removing stitches, among many other primary care conditions. They have turned a previously unused portion of their building into isolation rooms for sick visits and have a separate space with rooms for well-child checkups.

The biggest change for the practice is the introduction of telemedicine visits, which are interspersed during their day.

“I never wanted to do telemedicine,” Dr. Reddy says. “But we had to do something to see those kids who needed to be seen but would not come in. And we needed to do something to keep our practice viable. We knew there was going to be fear of contagion for a long time.”

Relying on experiences other practices shared through the American Academy of Pediatrics (AAP) Section on Administration and Practice Management (SOAPM) and other resources, Redbud launched a telemedicine site in 48 hours. Initially, group physicians were concerned about whether families would be willing to use the service. But after a week or doing a few visits, they agreed it was feasible. They sent an email to all their patients’ families and added instructions to their website, “and it’s really just taken off,” she says.

“Our families were so grateful and accepting of telemedicine, even with the limitations that it sometimes presents.”

Now, about half the visits they have with patients are telemedicine. The practice offers evening and weekend telemedicine appointments, too. Their practice visits, which were down by almost 50% a few weeks ago, have rebounded with the availability of telemedicine to about 80% of their previous volume.

One call they get often is from parents who think their infant is in respiratory distress. A video call allows the pediatrician to see the infant’s chest.

“Most of the time, their baby is not in distress,” she says. “We can teach them [parents] on the phone how to do saline drops and suction the nose out, and how to look for real signs and symptoms of distress in your baby’s breathing.”

Dr. Reddy said she has discovered some hidden benefits to telemedicine, such as being able to see the child’s home environment. For example, they can caution parents of children with asthma if they see doors or windows open during pollen season.

“I’m feeling good about moving forward,” Dr. Reddy says. She is certain she and her partners will continue using telemedicine from now on.

“We don’t think it’s ever going to go away now,” she says “Families ask me that on the phone now, at least once a day if not twice. ‘Are you still going to have this available?’ The families really love it.”

While adapting to telemedicine is one of the biggest improvements she sees coming out of this crisis, Dr. Reddy says there’s also something else.

“The other thing that I like,” she says, “is how the medical community has really come together because of this.”

The ABP would like to capture the many ways board-certified pediatricians are learning and improving care during this crisis. The mantra of many quality improvement collaborative networks is “share seamlessly, steal shamelessly.” Please let us know if there are ideas you’re willing to share. 

About Dr. Reddy: Rebecca Reddy is a general pediatrician and the founder/managing partner of Redbud Pediatrics in Wichita, KS. She grew up in a small Kansas farming community, earned her medical degree from the University of Kansas School of Medicine, and completed her pediatric residency at Baylor College of Medicine. She has been board-certified in general pediatrics for nearly 20 years and is meeting MOC requirements.

About the Author

David G. Nichols, MD, MBA

David G. Nichols, MD, MBA is the President and CEO of the American Board of Pediatrics (ABP). As leader of the American Board of Pediatrics (ABP) staff and a member of the nonprofit organization's Board of Directors, Dr. Nichols actively promotes high-quality health care for children by upholding the standards of certification in pediatrics and by encouraging and facilitating initiatives in quality improvement. Although he assumed his new leadership role in late 2012, he has been associated with the ABP for more than 20 years. He is board certified in General Pediatrics and is board certified and maintaining certification in Pediatric Critical Care Medicine.

Top photo: Dr,. Rebecca Reddy with a patient

Middle photo: Dr. Rebecca Reddy (center) with colleagues Kally Richardson (left) and Katrina Hinds (right)