Patient's families often feel disconnected from the medical team since they are not able to be present when the doctors come to the patients room. A large hospital sought to implement a telehealth solution by allowing the family would participate via a video chat system. This presentation seeks to predict the potential challenges that would be faced and propose solutions.

1. VIRTUAL ROUNDING
The User Experience

2. Virtual Rounding | Purpose
 Engaging the patient’s family
- recognizing the family as an essential member of
the healthcare team who provide key input into
many crucial decisions
 Sharing of key information “at the bedside”
- communicating during the patient encounter
- bypassing the need for the family member to be
there during early morning rounds

3. • Lack of family availability during the early morning call
• Lack of family preparation for the call,
e.g., no iPAD in hand
• “Who’s calling?”; “What do they want?”
• Too many voices in the background
• Poor imaging: unsteady camera, shaky or dizzying
visuals, loss of speaker sight-line, ceiling views
• Poor wireless connection, with image graininess,
image freezing, loss of connection
• Technical illiteracy
→ frustration for both parties
Virtual Rounding | Challenges

4. Educating the patient’s family
Standardizing the format
Addressing technical issues
Virtual Rounding | Solutions

5.  Set realistic expectations for the family member
• Confine session to 2-4 minutes
• Save issues requiring discussion for another time
• Preclude conversation between patient and family member
• Familiarize family member with use of the technology prior to the call
• Ensure family member is ready when the physician calls
Educating the patient
 Develop an enrollment process for family members, to
facilitate and standardize the encounter
- Avoid physician calling family members who are not ready for the call
• Develop enrollment process that affords reliable contact numbers, ensures family
has required technology at home and know how to use it, and sets clear
expectations
• Create a ‘sign-in’ system, wherein the family member calls in before rounding
starts and physician can see when the family member is connected and ready to
talk

6. Opening comments
• Physician’s name and title
• Physician’s location within the hospital
• Context and goal of the conversation
• Reminder of 5-minute limit – questions at other settings
New information from physician to family member
• Key new clinical findings or developments
New information from family member to physician
• PMHx, SHx, FHx, Allergies, Meds
• Social support system
Standardizing the format

7. Clip-on microphone
• Limits talk to one person at a time
• Reduces background noise
Mounted iPad
• Prevents shaking, ceiling view
• Frees physician’s hands for note writing and showing the chart
• Prevents viewing of other patients in 2-patient rooms
• Keeps speaker in view of the camera
IT preparation
• Consult for family member who are less technology savvy
• Tech assistant can join rounds and connect to family before doc enters
room
• Essential to have a wired connection or strong wireless, won’t freeze or
disconnect
Addressing the technical issues

8. • Prevents shaking, ceiling view
• Frees physician’s hands for note writing and showing the chart
• Prevents viewing of other patients in 2-patient rooms
• Keeps speaker in view of the camera
• Is connected via wired internet connection, much more reliable than wireless
• Battery never dies
• Can be bolted to wall to prevent theft
• Cost: iPad: $700- $1,100 Video Phone: $40 - $250
Using a video phone rather than an iPad

9. Concerns….
•Can the doctor give a reliable time window for the family to
be ready?
•With this system, the doctors’ primary connection to the
family will be in the presence of the patient, allowing him/her
to hear things that would have been better discussed
separately (not to upset, scare or confuse the patient). Will
the doctors find a good way to balance this?

10. Effective
Teamwork
Effective
Communication