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Pandemic pushes practice to pick up pace with telehealth :

April 26, 2020

Editor’s note:Pediatricians around the country have risen to the challenges posed by the coronavirus disease 2019 pandemic. Some are on the front lines battling the virus; others are connecting with patients while hunkered down at home. They are relying on creativity, ingenuity and tenacity to keep their patients healthy and their practices afloat. Here is one pediatrician’s story.

The pivot to virtual communications for patient care and staff communications was a challenge for many practices.

For Tamalpais Pediatrics in Larkspur and Navato, Calif., operational challenges generally were manageable, thanks to early telehealth adoption that fell into place at the right time.

The practices had been utilizing telehealth for behavioral care for more than a year and ramping up use for acute care in recent months. So, when patient visits to the office decreased, the familiarity with the technology and an established workflow helped expedite integration of telehealth on a greater scale.

“We were already jogging. We just had to start running,” said Nelson Branco, M.D., FAAP, a member of the practice staff and AAP California Chapter 1 vice president.

Like so many practices with diminishing well visits, these pediatricians are finding gaps in their schedules. Scanning their patient rosters, they identify children with chronic illnesses, such as asthma or anxiety, and contact parents to offer televisit check-ins.

“It is satisfying to me to have a little bit of time to talk with the patient about their condition and how they are handling shelter in place. Parents appreciate it also,” Dr. Branco said.

With the near daily updates about COVID-19 and its impact on practice, communication among staff is critical. A relatively new phone system that works as a virtual network makes it possible for most of the practices’ staff to work from home. Each morning, the practices have a telehuddle where they discuss “Where we are today. What is our plan? What we’re changing.”

It’s been helpful to discuss cases as a team, Dr. Branco explained. “If we have a case that we think merits testing, we can discuss it. Not so we can talk each other out of doing what is clinically indicated. It’s so we all get a sense of what is each other’s threshold for testing and their criteria for testing, so that we have consistency in the group.”

During these challenging times, “What rings true for me,” Dr. Branco said, “is the importance of communication and flexibility.”

To read other pediatricians’ stories, visit

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