Implementing a COVID-19 Virtual Observation Unit in Emergency Medicine: Frontline Clinician and Staff Experiences

Abstract

The COVID-19 pandemic pushed hospitals to deliver care outside of their four walls. To successfully scale virtual care delivery, it is important to understand how its implementation affects frontline workers, including their teamwork and patient-provider interactions. We conducted in-depth interviews of 17 clinicians and staff involved with the COVID-19 Virtual Observation Unit (CVOU) in the emergency department (ED) of an academic hospital. The program leveraged remote patient monitoring and mobile integrated health care. In the CVOU (vs. the ED), participants observed increases in interactions among clinicians and staff, patient participation in care delivery, attention to nonmedical factors, and involvement of coordinators and paramedics in patient care. These changes were associated with unintended, positive consequences for staff, namely, feeling heard, experience of meaningfulness, and positive attitudes toward virtual care. This study advances research on reconfiguration of roles following implementation of new practices using digital tools, virtual work interactions, and at-home care delivery.

Patient Experience With an In-Home COVID Virtual Observation Unit: An Analysis

“…Prior studies have proven the importance of patient experience on program feasibility, health outcomes, and provider satisfaction. 7 - 11 , 15 . Very few have measured patient experience with home-based care provided by emergency medicine teams, and none with a CVOU care model incorporating both remote symptom monitoring and MIH resources.…”

Can tablet video‐based telehealth assessment of the abdomen safely determine the need for abdominal imaging? A pilot study

“… 15 There are care models that use video‐based telehealth examinations with other health care professionals at the patient's bedside, such as community paramedics on site in a patient's home to facilitate a video visit with a clinician. 16 These health care team members could palpate a patient's abdomen and obtain a set of vital signs to improve the reliability of the physical examination. Future studies could determine the reliability of the video‐based abdominal examination with other health care team members or care partners present with the patient and gathering data for the health care clinician.…”

“…The use of care partners in a video‐based abdominal examination raises potential ethical issues with undue discomfort to a patient or care partner in performing an abdominal examination 15 . There are care models that use video‐based telehealth examinations with other health care professionals at the patient's bedside, such as community paramedics on site in a patient's home to facilitate a video visit with a clinician 16 . These health care team members could palpate a patient's abdomen and obtain a set of vital signs to improve the reliability of the physical examination.…”

Pediatric capacity crisis: A framework and strategies to prepare for a pediatric surge

“…Finally, another way to increase inpatient pediatric capacity is to expand the range of services that can be provided at home. For adults, hospital‐at‐home programs were developed during the COVID‐19 pandemic that remotely monitored patients at home, provided oxygen therapy, 41 and employed paramedics for in‐home evaluations 42 . During pediatric surges, hospitals could develop programs similar to Children's Hospital Colorado's home oxygen therapy program for children with bronchiolitis 43 …”

“…For adults, hospital-at-home programs were developed during the COVID-19 pandemic that remotely monitored patients at home, provided oxygen therapy, 41 and employed paramedics for in-home evaluations. 42 During pediatric surges, hospitals could develop programs similar to Children's Hospital Colorado's home oxygen therapy program for children with bronchiolitis. 43 In addition, telehealth can expand ED capacity.…”