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).

In the wake of a pandemic that forced the closing of many health care practices, USF Health quickly found a way to keep making life better for patients and families across the Tampa Bay area.  Telehealth appointments have been how patients have stayed connected to our health care teams when in-person visits were reduced.  USF Health recently hit a new milestone for its telehealth efforts.

USF Health recently surpassed 100,000 telehealth appointments.

“This is a stunning number, and truly a testament to the strength of our team to accomplish such a feat amidst a worldwide global pandemic,” said Mark Moseley, MD, USF Health associate vice president and chief medical officer.  “Our telehealth efforts helped the practice plan survive during the early days of the crisis and has continued to enable our road to recovery.“

Top 10 specialties with the most completed telehealth appointments from March 18 to Oct. 30:

• Department of Pediatrics: 16,030
• Department of Cardiology: 12,803
• Department of Psychiatry and Behavioral Neurosciences: 12,583
• Department of Internal Medicine: 12,384
• Department of Neurology: 10,386
• Department of Family Medicine: 6,329
• Department of Obstetrics and Gynecology: 6,161
• Department of Urology: 4,610
• Health Informatics Institute: 4,404
• Department of Neurosurgery: 3,332

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

The COVID-19 pandemic is having a lasting impact on the way we live, work and interact. Watch Dr. Bryan Bognar, vice dean of the Morsani College of Medicine Department of Medical Education, discuss USF Health’s medical education successes and challenges due to the COVID-19 pandemic.

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The COVID-19 pandemic is having a lasting impact on the way we live, work and interact. Watch Dr. Terri Ashmeade, chief quality officer at USF Health, discuss patient safety in the clinics.

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The COVID-19 pandemic is having a lasting impact on the way we live, work and interact at USF Health. Watch Jacqueleen Reyes Hull, Ed.D, assistant vice president for administration at USF Health, discuss how daily life has changed for faculty and staff.

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USF Health medical student Tampa Hutchens discusses how the COVID-19 pandemic has affected medical education and what students and USF faculty have done to keep their medical training on track.

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USF Health Dean of the Taneja College of Pharmacy Dr. Kevin Sneed discusses the role pharmacists play in responding to the COVID-19 pandemic. Dr. Sneed stresses how pharmacists are helping find promising treatments, connecting with patients virtually to go over their medication regimens and further strengthening the healthcare sector’s approach to fighting the pandemic.

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USF Health Dean of Public Health, Dr. Donna Petersen, discusses the importance of public health especially during pandemics like COVID-19. Dean Petersen stresses the importance of following CDC guidelines — washing hands thoroughly, wearing a mask and maintaining social distance — to avoid contracting and spreading COVID-19. Dr. Petersen leads the COVID-19 Task Force and lays out plans to reopen USF to students, faculty and staff.

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Nurses protect the health and well-being of patients every day and play an integral role in our nation’s health care system. In the latest USF Health Brief, Dr. Usha Menon, interim dean of the USF Health College of Nursing, discusses the challenges and changes nurses and nurse training face during the COVID-19 pandemic.

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Dr. Stephen Liggett, USF Health associate vice president for research, discusses how COVID-19 has changed how research is conducted and the types of conditions researchers work.

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Dr. Deborah DeWaay, USF Health associate dean of undergraduate medical education, discusses the current and long-term changes in medical education due to the COVID-19 pandemic.

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Dr. Mark Moseley, USF Health’s Chief Clinical Officer, discusses how physicians and other health care providers are using telehealth services and technology to remotely care for patients, especially amid the COVID-19 pandemic.

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In the first USF Health Briefs, Dr. Charles Lockwood, Dean of the Morsani College of Medicine, talks about how the COVID-19 pandemic has changed our way of life and access to health care, the lessons the virus is teaching the medical community, and how long it may take before we can safely mingle in large groups again.

USF Health medical student Tampa Hutchens discusses how the COVID-19 pandemic has affected medical education and what students and USF faculty have done to keep their medical training on track. This is the final episode in an eight-part series looking at the way COVID -19 is impacting the way we live, work and access health care.

USF Health Dean of the Taneja College of Pharmacy Dr. Kevin Sneed discusses the role pharmacists play in responding to the COVID-19 pandemic. Dr. Sneed stresses how pharmacists are helping find promising treatments, connecting with patients virtually to go over their medication regimens and further strengthening the healthcare sector’s approach to fighting the pandemic. This is the seventh in an eight-part series looking at the way COVID -19 is impacting the way we live, work and access health care.

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.

In the wake of the COVID-19 pandemic, USF Health continues to find ways to innovate and collaborate to benefit the Tampa Bay area.  A recent effort is the creation of the COVID-19 Confirmed Clinic.

The virtual clinic provides follow-up services to COVID-19 patients discharged from Tampa Bay area hospitals as part of a telemedicine outpatient clinic. The clinic has tracked more than 700 patients since its launch in early April.  Virtual appointments offer volunteers a way to track continued symptoms and well as help patients on the road to full recovery.

Medical students, along with nurse practitioner students, play a couple of vital roles within the clinic which include regularly following up with patients and building databases that will help analyze whether certain factors contribute to COVID-19 risk or protection.  Senior USF Health student volunteers conduct regular welfare checks, offer support and discuss any symptoms that haven’t been resolved.

“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 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. ”

“Our COVID19 Confirmed clinic, COCo for short, has been an important part of our great TGH/USF response to the pandemic,” 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. “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. 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 including internal medicine, med-peds and pediatric resident physicians, senior medical students, nurse practitioner students and physician assistant students. Over 150 trainees have played a part in the care of over 680 patients since the beginning of the project”

Dr. Perez-Colon predicts that the clinic will play a key role as the Tampa Bay area slowly continues to open back up. Other hospital organizations in the southeast region of the United States have taken notes on what she and her team have accomplished in a short amount of time.  She said it’s important for hospitals and health care organizations to continue to collaborate if the goal is to help prevent future outbreaks.

Clinic leaders are working with their partners in Tampa General Hospital and the Florida Department of Health to make the clinic a permanent resource for the Tampa Bay community.  As part of their business proposal, the space would also be used to conduct critical COVID-19 research.

CoCo Clinic statistics as of June 1, 2020:

• 1351 Total patients
• 103 telehealth appointments completed
• 4 in-person appointments completed
• 29 patients’ vitals monitored via EPIC Care Companion
• 10 patients’ vitals monitored via Masimo

In the latest USF Health Brief, Dr. Mark Moseley, USF Health’s Chief Clinical Officer, discusses how physicians and other health care providers are using telehealth services and technology to remotely care for patients, especially amid the COVID-19 pandemic.

The current coronavirus outbreak is not preventing USF Health patients from seeing their providers.

As the pandemic grew last week and most of Florida shifted to working remotely – and many health care facilities halted in-person patient visits – USF Health quickly ramped up its telemedicine capabilities across the faculty practice.

At home, a USF Health patient connects with Jen Farrant, administrator with USF Health Family Medicine.

The effort launched on Monday March 16 and by Friday March 20 most clinics had initiated components of telehealth. From that point on, teams of support staff contacted hundreds of patients to move in-person appointments into telehealth appointments.

“Within a matter of days, our patients were able to get the care they needed using technology to connect with our specialists,” said Mark Moseley, MD, MHA, chief clinical officer for USF Health and chief medical officer for the USF Health faculty practice plan.

“This type of patient experience – using remote capabilities to care for our patients – has been on our horizon for a long while. The current COVID-19 outbreak and the crisis our country is experiencing pushed telehealth to the forefront. Our team did a tremendous job of responding to this adversity and to push forward a functional solution in a little over a week. Simply amazing.”

And patients are accepting this new format, relieved to be able to maintain connections with USF Health providers, he said.

USF Health has been poised for telehealth, but federal guidelines for use was limited. Due to COVID-19, the U.S. Congress lifted restrictions on reimbursement for telehealth through Medicare, opening the technology to widespread use when patients are limited in traveling to get medical care.

Family Medicine administrator Jen Farrant helps a patient connect with USF Health.

While not every patient appointment can be done virtually, most can or at least can be initiated in that capacity with in-person follow up appointments planned.

“There are still conditions and symptoms our patients are experiencing that warrant coming to our clinics,” Dr. Moseley said. “We will still see patients in-person who have urgent medical needs. However, a telehealth appointment for most patients will meet their needs, while mitigating the risk of being out in public during this epidemic outbreak. It’s a prudent starting point for determining the best next steps.”

USF Health, along with the rest of the university, was already using a program for conducting business and academic meetings remotely. Called Microsoft Teams, the program is fairly intuitive, offering both video and audio interaction, and supported by many options for sharing documents, scheduling, and follow up details.

The experience has been well received by patients, said Renée Dubault, chief operating officer and associate executive director of Business Operations for USF Health.

“Patients are saying they are grateful we are making it available and appreciate the option to continue with their care with our specialists,” Dubault said. “Our staff has embraced our expansion of telehealth and the ingenuity that has come about to build this up so quickly has been terrific.”

Most of USF Health’s clinical specialties have added this telehealth component. Visit the USF Health telehealth page for more details. And to find out if your appointment can happen through remote telehealth, contact USF Health at 813-974-2201.

Photos by Freddie Coleman, USF Health Communications and Marketing.