Patient- and Family-Centered Video Rounds in the Pediatric Intensive Care Unit

Abstract

Objective: Management of the coronavirus disease 2019 (COVID-19) pandemic has required social distancing requirements and personal protective equipment shortages, which have forced hospitals to modify patient care rounds. We describe our process developing telemedicine rounds to maintain synchronous, multidisciplinary, pediatric intensive care unit rounds. By adapting available resources using rapid process improvement (PI), we were able to develop patient- and family-centered video rounds (PFCVR). Design: When rounding team members were forced to work from home, we adapted an existing telemedicine platform (VidyoConnect) to perform PFCVR. A quality improvement (QI) team developed an initial standard process, which underwent rapid PI using a small multidisciplinary team. Setting: A 21-bed, mixed medical/surgical/cardiac pediatric intensive care unit. Participants: Critical care patients, families, physicians, consultants, nurses, and ancillary staff. Interventions: The QI team initially met daily, then weekly, sought feedback from nurses, families, and other care providers, and utilized small tests of change to improve the rounding process. Results: We established standardized, socially distanced rounds using VidyoConnect to allow synchronous, multidisciplinary PFCVR. Implementation of a schedule and rounding script facilitated efficient and effective team communication, optimized participation by the entire team, and decreased interruptions. Conclusions: The COVID-19 pandemic compromised the feasibility of the previous rounding process. PFCVR is a safe and effective tool to facilitate communication while adhering to social distancing guidelines. Use of available platforms and team-based PI is critical for successful implementation.

A survey on Canadian pediatric hospital clinical/medical teaching unit implementation during the first and second wave of the COVID-19 pandemic

“…As a consequence of the COVID-19 pandemic, few publications have discussed the implementation of rounding with results similar to what we found in our survey, e.g., the use of smaller groups, virtual video chat, telephone, and using call rooms [10,13,14,[16][17][18]. DeSanti et al discuss patient-and family-centered Fig.…”

“…While our literature search identified some publications on the changes to medical student teaching or specific medical speciality teaching (e.g., surgery, medical units) during COVID-19 [8][9][10][11][12][13], only one was specific to pediatric rounds [14]. There has been a recent publication regarding the transition to virtual family-centred rounds, where the authors describe their process of daily, virtual family-centered rounds at the Children's Hospital of Eastern Ontario [15].…”

Physician Perspectives on the Impact of the COVID-19 Pandemic on Family-Centered Rounds

“…Virtual team rounds have been described in adult and pediatric settings 7,8,[15][16][17]24 ; virtual rounds with a standardized rounding script led to decreased faculty variation and better inclusion of nurses and physicians. 25 Achieving a shared mental model with the care team is a key FCR principle that may be sustained through technological approaches ranging from telephone calls and messaging to videoconferencing.…”

“…A growing body of literature describes novel techniques for teaching during the COVID-19 pandemic, although few studies specifically address challenges with teaching, modeling, and supervising communication and soft skills during rounds. 9,25,[27][28][29] Virtual FCR may present opportunities to model effective family and medical team communication but notably lack patient physical examination and may have decreased time for teaching within the structured format. 25 Those providing teaching services may wish to consider other means of modeling and evaluating communication (eg, simulation) in the absence of typical in-person opportunities afforded during FCR.…”

“…9,25,[27][28][29] Virtual FCR may present opportunities to model effective family and medical team communication but notably lack patient physical examination and may have decreased time for teaching within the structured format. 25 Those providing teaching services may wish to consider other means of modeling and evaluating communication (eg, simulation) in the absence of typical in-person opportunities afforded during FCR.…”