Jul 02 2020

Virtual Rounding Supports Communication During a Pandemic

Mobile devices and collaboration platforms help clinicians perform rounding duties safely (and efficiently) from anywhere.

Telehealth solutions have aided the treatment of acute stroke patients at UC San Diego Health for two decades. 

But many inside the organization, including Dr. Brett Meyer, medical director of enterprise telemedicine, have been pushing for a wider deployment of virtual care — including routine rounding practices, which involve various disciplines coming together to discuss a patient’s condition and coordinate care.

The COVID-19 pandemic made that vision a reality. 

A few weeks after the coronavirus crisis hit the U.S., UC San Diego Health was able to roll out Virtual Visits, a remote rounding tool that incorporates mobile devices, collaboration platforms and the Apple management solution Jamf

Now, a clinician can click on a patient’s room number using the hospital’s directory, and the patient will receive a notification to join a Zoom meeting from an iPad device in his or her room.

“The patients are thrilled with the solution,” Meyer says. “And from a provider perspective, not only are you able to provide the same level of care but you’re able to do a better job of making sure your team is informed.”

READ MORE: Learn how ‘tele-triage’ models work to keep patients and clinicians safe. 

Using the Virtual Visits tool, UC San Diego Health physicians and team members can connect from different physical rooms before a virtual interaction with a patient to share images and offer clinical recommendations. 

Such efforts also conserve personal protective equipment and create more physical distance between providers and patients to prevent transmission of the coronavirus. 

And they’ve improved the learning process: “Previously, you might not have had time to show an X-ray to everyone on rounds team,” Meyer says. “But in a virtual sit-down, you can pull the X-ray up and do the teaching on that image.”

Impactful Solutions Come from Combining Technologies

A number of technologies have recently come together to assist clinicians at Nemours Children’s Health System in Jacksonville, Fla., where eight to 14 care providers used to huddle with a parent during rounds.

“But with social distancing, we couldn’t do that anymore,” says Carey Officer, operational vice president at the Center for Health Delivery Innovation at Nemours.

That led the organization to create a secure app for virtual rounding. The app leverages tools that include the VidyoConnect enterprise meeting solution, Milestone XProtect video management software, in-room cameras and mobile devices. 

Dr. Brett Meyer, Medical Director of Enterprise Telemedicine, UC San Diego Health
From a provider perspective, not only are you able to provide the same level of care but you’re able to do a better job of making sure your team is informed.”

Dr. Brett Meyer Medical Director of Enterprise Telemedicine, UC San Diego Health

Now, using the app, two care providers and a parent stand outside a patient’s room (with participants spaced 6 feet apart), passing a video cart back and forth to engage with other members of the team located remotely. 

Dr. Patrick Barth, a pediatric otolaryngologist at Nemours/Alfred I. duPont Hospital for Children in Wilmington, Del., recently performed an airway procedure on a child. From a satellite clinic, Barth was able to use the same rounding technologies for follow-up visits as the child recovered in intensive care. 

“I got to participate in virtual rounds with the attending physician and team, all in a virtual setting — in addition to having the ability to see the mom and the child, and take care of them in the same fashion I would have if I had been present,” says Barth. 

Some virtual rounding efforts, however, involve an in-person element. At the University of Louisville School of Medicine in Kentucky, physicians are relying on wearables to help remotely deliver care to senior care settings during the coronavirus crisis. 

By wearing a pair of Vuzix M400 smart glasses and connecting through Zoom, an onsite nurse practitioner can serve as the “eyes” of a remote physician during rounds. 

“They’re providing a view for a remote expert,” says Dr. R. Brent Wright, the school’s associate dean for rural health innovation. “Let’s say they see a rash. Now, you can describe a rash, but if you can show that rash through video, you can move quickly to developing a treatment plan.”

Improving the Patient Experience Starts with a Personal Connection

Many hospital patients are using telemedicine services for the first time due to the coronavirus crisis, says Wright. He predicts these experiences will contribute to the explosive growth and acceptance of telehealth — and that new workflows developed during the pandemic will endure. 

Despite the circumstances, “they’re having a wonderful experience,” says Wright, adding that he expects to see a wider use of smart glasses in healthcare settings. “We’re going to find that this is a very valuable tool going forward.” 

Dr. Michael Usher, an assistant professor of medicine at the University of Minnesota, is conducting research on the effectiveness of virtual rounding. He says the effort is a proven way to reduce PPE use, and it has helped patients being treated for COVID-19 feel less isolated. 

Still, existing virtual rounding systems can have limitations for patients who don’t speak English or lack experience with technology. “The biggest lesson is to take into consideration usability and accessibility,” Usher says.

Meyer, of UC San Diego Health, says that virtual rounding will not displace in-person practices but rather will provide more opportunities for dialogue between providers and patients. 

For instance, a physician might use the virtual rounding system to personally deliver a favorable test result before going home for the day, rather than making the patient wait until the next rounding. Such simple yet meaningful exchanges will always have value. 

“Once COVID is gone, we still have a situation where we would love to be able to interface with patients more frequently,” Meyer says. “The fact is, the technology is there to fill a need, and that need was there before COVID. We’re never going back.”

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