Background: Inadequate counseling at patient discharge from the emergency department can lead to adverse patient outcomes. Virtual discharge counseling can address gaps in discharge counseling and improve patients' understanding of instructions. Methods A previously established virtual discharge counseling program was scaled across three emergency departments and expanded to 13 diagnoses. Utilizing a standardized protocol and script, counselors performed virtual discharge counseling via a remote, secure teleconference platform in the patients' preferred language. Results: Virtual discharge counseling was performed with 166 patients. COVID-19, back pain, and headache were the most frequent diagnoses. The median counseling time was 14 min. Median counseling time for English was 11 min, versus 20 min for other languages (p < 0.001). Counseling times were the longest for COVID-19 and diabetes (18 min for each). Conclusion: We demonstrate the scalability of a virtual discharge counseling program. Our findings can assist in targeting virtual discharge counseling resources for limited English-proficiency patients and specific diagnoses that require longer counseling times.

Background During the COVID-19 pandemic, we identified a gap in adequate discharge counseling for COVID-19 patients in the Emergency Department. This was due to high patient volumes and lack of patient education regarding a novel disease. Medical students were also restricted from clinical areas due to safety concerns, compromising their clinical experience. We piloted a novel program in which medical students served as virtual discharge counselors for COVID-19 patients via teleconference. We aimed to demonstrate an impact on patient care by examining the patient bounce back rate as well as assessing medical student education and experience. Methods This program was piloted in a tertiary care Emergency Department. Medical student volunteers served as virtual discharge counselors. Students were trained in discharge counseling with a standardized protocol and a discharge script. Eligible patients for virtual discharge counseling were 18 years old or greater with a diagnosis of confirmed or suspected COVID-19 and no impediment precluding them from participating in a telemedicine encounter. Counseling was provided via secure teleconference in the patient's preferred language. Counseling included diagnosis, supportive care with medication dosing, quarantine instructions, return precautions, follow up, and time to ask questions. Duration of counseling was recorded and medical students were anonymously surveyed regarding their experience. Results Over an 18-week period, 45 patients were counseled for a median of 20 min. The 72-hr ED revisit rate was 0%, versus 4.2% in similarly-matched, not counseled COVID-19 patients. 90% of medical students believed this project increased their confidence when speaking with patients while 80% indicated this was their first telemedicine experience. Conclusion Our pilot discharge program provided patients with an extensive discharge counseling experience that would not otherwise be possible in an urban ED setting and demonstrated benefit to patient care. Medical students received a safe clinical experience that improved their communication skills.