Virtual Team Rounding: A Cross-Specialty Inpatient Care Staffing Program to Manage COVID-19 Surges

Abstract

Problem The SARS-CoV-2 (COVID-19) pandemic presented numerous challenges to inpatient care, including overtaxed inpatient medicine services, surges in patient censuses, disrupted patient care and educational activities for trainees, underused providers in certain specialties, and personal protective equipment shortages and new requirements for physical distancing. In March 2020, as the COVID-19 surge began, an interdisciplinary group of administrators, providers, and trainees at Brigham and Women’s Hospital created an inpatient virtual staffing model called the Virtual Team Rounding Program (VTRP). Approach The conceptual framework guiding VTRP development was rapid-cycle innovation. The VTRP was designed iteratively using feedback from residents, physician assistants, attendings, and administrators from March to June 2020. The VTRP trained and deployed a diverse set of providers across specialties as “virtual rounders” to support inpatient teams by joining and participating in rounds via videoconference and completing documentation tasks during and after rounds. The program was rapidly scaled up from March to June 2020. Outcomes In a survey of inpatient providers at the end of the pilot phase, 10/10 (100%) respondents reported they were getting either “a lot” or “a little” benefit from the VTRP and did not find the addition of the virtual rounder burdensome. During the scaling phase, the program grew to support 24 teams. In a survey at the end of the contraction phase, 117/187 (62.6%) inpatient providers who worked with a virtual rounder felt the rounder saved them time. VTRP leadership collaboratively and iteratively developed best practices for challenges encountered during implementation. Next Steps Virtual rounding provides a valuable extension of inpatient teams to manage COVID-19 surges. Future work will quantitatively and qualitatively assess the impact of the VTRP on inpatient provider satisfaction and well-being, virtual rounders’ experiences, and patient care outcomes.

The Utilization of Health Informatics Interventions in the COVID-19 Pandemic: A Scoping Review

“…The Telehealth technology category had 20 related articles and was the second most utilized intervention. For example, Becker et al concluded in their article that a valuable way to manage COVID-19 surges is virtual rounding [12]. Along a similar line, Hannemann et al found that digital health technologies can provide a platform to expand the offering of healthcare services [13].…”

Impact of the COVID-19 Pandemic on Medical Education during Inpatient Internal Medicine Rounds

“…[2][3][4] Strategies included rounding via telephone or video-based conferencing platforms and limiting the number and proximity of rounding team members. 5 Some graduate medical education programs initially restricted trainees from providing direct care to patients with COVID-19, 6 and accreditation bodies recommended temporarily withdrawing students from patient-facing activities. 7 Although well intentioned, these changes may have affected clinical education during rounds.…”

“…As the coronavirus disease 2019 (COVID-19) pandemic spread across the United States in spring 2020, inpatient IM teams developed virtual and hybrid modifications to traditional inpatient rounding to mitigate potential nosocomial transmission of severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) and to conserve personal protective equipment (PPE) 2–4 . Strategies included rounding via telephone or video-based conferencing platforms and limiting the number and proximity of rounding team members 5 . Some graduate medical education programs initially restricted trainees from providing direct care to patients with COVID-19, 6 and accreditation bodies recommended temporarily withdrawing students from patient-facing activities 7…”

Residency Training in the COVID-19 Pandemic—Addressing the Need for Systems-Based Education

“…They were actively involved in efforts to optimize triaging of patients, turn emerging evidence into guidelines, and create multidisciplinary teams to improve care. [7][8][9][10] With little preparation, trainees brought their strong work ethic, eagerness to learn, and readiness to question norms to improving systems and those who practice within them. By being involved in firsthand, real-time systemic endeavors, residents contributed to academic health systems while learning how to practice independently within them.Author affiliations and article information are listed at the end of this article.…”

“…When academic health systems faced unprecedented hospital admissions and rapidly shifting treatment paradigms, frontline residents reliably contributed to improvement endeavors. They were actively involved in efforts to optimize triaging of patients, turn emerging evidence into guidelines, and create multidisciplinary teams to improve care . With little preparation, trainees brought their strong work ethic, eagerness to learn, and readiness to question norms to improving systems and those who practice within them.…”