Health system pieces together ‘virtual rounding’ to cope with pandemic

Because of the COVID-19 pandemic, Jacksonville, Florida-based Nemours Children’s Health System needed to quickly revamp rounding by leveraging existing technology and infrastructure to avoid unnecessary contact and personal protective equipment use.

PROPOSAL

Nemours leveraged the power of several technologies to create its solution. It is using the VidyoConnect secure app for rounding, team communication and teaching; Epic monitor for remote access to in-room cameras for both the health system’s Clinical Logistics Center and the eICU at Nemours/Alfred I. duPont Hospital for Children; and a new app, Milestone XProtect, from any desktop or laptop computer enterprise-wide that enables access to in-room cameras.

Milestone, along with repurposing of the health system’s existing Cisco phone system, enables physicians to remotely examine patients and communicate with parents who may be sequestered in the patient’s room during the COVID-19 crisis.

MEETING THE CHALLENGE

“The first problem we looked at was the typical large group of people [12 to 14] who do daily hallway rounding on patients,” said Carey Officer, operational vice president of Nemours CareConnect and the Center for Health Delivery Innovation at Nemours Children’s Health System. “We wanted to take advantage of the technology we had in place in order to reduce to a maximum of three people rounding on a given patient.”

This triangle consists of the resident, one bedside nurse and the parent, spaced 6 feet apart. The attending physician, additional resident staff and fellow are located at various workstations on the floor, or in a conference room. The resident is signed onto the iPad cart in the hallway and presents the patient remotely through the Vidyo connect secure app, then hands off to the nurse, who reviews the patient’s checklist and goals.

The team of specialists and caregivers participate face to face using their own devices, allowing the core group to remain involved, including specialist physicians, pharmacist, social worker, dietitian and others.

“Everyone is separate – at home or elsewhere – but connected via the secure app and able to interact with the parent and hallway team, the resident and fellow in the hospital, and each other,” Officer explained. “We have found that facilitating virtual patient rounding has brought the entire care team together at the same time. Pre-COVID, the care team would round throughout the day as their schedules allowed. This was an unintended but very positive consequence of cohesive care coordination during rounding.”

The second problem Nemours was trying to solve related to potential COVID-19-positive inpatients and the need to preserve PPE.

“Our clinical logistics center located in Orlando can camera into every inpatient room at the two children’s hospitals in the Nemours health system: Alfred I. duPont Hospital for Children in Wilmington, Delaware, and Nemours Children’s Hospital in Orlando. Linking the technology of the logistics center with a new platform, the Milestone XProtect camera app, allows us to see the whole room and zoom into specific areas, from any desktop/laptop. That’s the video component.”

In order to talk to parents and nurses in the patient room, staff connect using the existing Cisco phone system in the room or via an individual nurse’s Voalte device. Thus, from anywhere, system-wide, staff have access to real-time audio and video communication without multiple people making multiple trips into and out of the patient room, and doffing PPE each time.

“The PICU started using the Milestone app, now it’s in use throughout both of our hospitals,” Officer noted. “Providers can round from anywhere, go room to room on the unit, and see multiple patient rooms on the screen at one time.”

Nurses, residents and attending physicians staffing the units can use telemedicine instead of entering the room to minimize exposure and PPE use, for duties such as double-checks on medication. This practice decreases risk and use of resources and saves time and potential injury to patients and staff.

“This is a new form of telemedicine,” Officer stated. “We’re not going back after COVID.”

RESULTS

Nemours has been conducting about 340 virtual rounding visits per week since it went live with the new system at the end of March. And it is saving personal protective equipment at a time when it is needed most.

ADVICE FOR OTHERS

“Inpatient virtual rounding is novel, but Nemours was able to make it happen in a matter of days in a crisis situation,” Officer noted. “We had some advantages: our clinical logistics center, created in 2012, that remotely monitors every patient room; a dedicated solutions-oriented telehealth team that includes physicians and IT specialists; and Nemours’ strategic focus on innovation for healthcare delivery and investment in sophisticated technology.”

With dedicated teamwork, Nemours was able to innovate and problem-solve quickly, she added.

“I would advise any healthcare team to start where they are: leverage current technology that exists or invest inexpensively in a solution that solves the problem, deploy knowledgeable frontline staff who understand processes best, and deploy a minimal viable solution to learn what works well for your organization,” she concluded. “Once you work out the kinks, scale it.”