Virtual Communication Embedded Bedside ICU Rounds: A Hybrid Rounds Practice Adapted to the Coronavirus Pandemic

Abstract

Coronavirus disease 2019 containment strategies created challenges with patient-centered ICU rounds. We examined how hybrid rounds with virtual communication added to in-person rounds could facilitate social distancing while maintaining patient-centered care. DESIGN: Continuous quality improvement.SETTING: Quaternary care referral pediatric hospital.PATIENTS: Daytime rounds conducted on PICU patients. INTERVENTIONS:Following a needs assessment survey and pilot trials, multiple technological solutions were implemented in a series of plan-do-study-act cycles. Hybrid rounds model was deployed where a videoconference platform was used to establish communication between the bedside personnel (nurse, patient/family, and partial ICU team) with remotely located remaining ICU team, ancillary, and consultant providers. Floor labels marking 6-feet distance were placed for rounders. MEASUREMENTS AND MAIN RESULTS:Outcome metrics included compliance with social distancing, mixed methods analysis of surveys, direct interviews of providers and families, and reports of safety concerns. The clinicians adopted hybrid rounds readily. Compliance with social distancing and use of floor labels needed reminders. One-hundred fourteen providers completed the feedback survey. Twenty-five providers and 11 families were interviewed. Feedback about hybrid rounds included inability to teach effectively, suboptimal audio-video quality, loss of situational awareness of patient/unit acuity, alarm interference, and inability to socially distance during other ICU interactions. Benefits noted were improved ancillary input, fewer interruptions, improved efficiency, opportunity to integrate with data platforms, and engage remote consultants and families. Nurses and families appreciated the efforts to ensure safety but wanted the ICU attending/fellow supervising the team to participate at bedside, during rounds. Clinicians appreciated the multidisciplinary input but felt that teaching was difficult. CONCLUSIONS:Hybrid rounds employed during pandemic facilitated social distancing while retaining patient-centered multidisciplinary ICU rounds but compromised teaching during rounds. A change to ingrained rounding habits needs team commitment and ongoing optimization. The hybrid rounds model has potential for generalizability to other settings.

The Impact of Digital Health Transformation Driven by COVID-19 on Nursing Practice: Systematic Literature Review

“…It contains any issues that users find in using the systems. The studies on telehealth reported that screen freezing, audio delays [ 20 , 24 , 34 ], and alarm interference [ 29 ] impacted their interaction with patients during the virtual visits. As health care organizations rapidly implemented telehealth during the pandemic and workflows highly increased, there was a heavy load of data entry and a lack of time for it and documentation [ 26 ].…”

“…The increased use of digital health has added another layer of interruption. Inconsistency in team communication [ 28 , 29 ]; difficulties in scheduling procedures [ 28 , 32 ], setting up different accounts, and obtaining various consents [ 30 ]; and constant updates [ 19 ] were among the issues the studies raised about workflows. The nurses were concerned about having the full responsibility for connectivity [ 23 ], which required extra time to communicate and coordinate visits [ 16 , 20 , 23 , 26 ], in turn limiting the number and efficiency of telehealth visits.…”

“…The shortage of funding and reimbursement models was a significant internal issue that impacted the implementation of digital health use during the past 2 years [ 17 , 21 , 24 , 25 , 33 , 34 ]. The studies reported a lack of strategies and policies for integrating different tools across health care settings, workflows, training, and preparedness [ 17 , 29 , 31 ]. In addition, once the pandemic escalated, limited equipment was available for telehealth services [ 19 ].…”

“…The other digital health service applied during the pandemic was tele-ICU, explored in 4 studies, to keep the optimal distance between the control team and clinical providers within acute care departments. The studies showed overall satisfaction with the service that improved the workflow, teamworking, and patient-centered care [ 27 - 29 , 35 ].…”

“…System-level challenges exist in navigating payment models offered by different insurance companies, licensure, and litigation issues [ 24 ]. Nurses raised concerns about poor phone connectivity that hampered communication and jeopardized patient safety [ 29 ]. They felt that telehealth consultations increase their responsibility for connectivity and intake, which would severely limit the volume and efficiency of telehealth services [ 23 ].…”