As hospitalist regional director at Adventist Health Hanford (California), our team implemented tele-rounding in the summer of 2020 when a COVID surge abruptly doubled our rural hospital’s census.
In partnership with hospital leadership, including our medical director Maria Marmol, MD, we designed a virtual rounding strategy that fit into the department’s existing workflows. We really built our process around the nurses, because we depended on them to take the iPads to the patients, and we wanted to implement this in a way that didn’t add to their load.
To accomplish this, the hospitalist would check in with nursing each morning to hear patient updates and schedule virtual visits. When possible, they overlapped tele-rounding with nursing tasks like medication administration or hourly checks.
The predictability of this process was a huge patient satisfier. Patients often get anxious waiting for the hospitalist. They’re always asking the nurses when they will see the doctor. So, having that visit scheduled each day was very reassuring. And the nurses appreciated it too.
Tele-rounding also made it easier for families to participate in their loved one’s care. At first it was a little chaotic with the nurse and the doctor and the family together on FaceTime. But with some practice, we were able to make sure all voices were heard, and questions were answered.
The process even had a few unanticipated benefits. Patients told us that they could hear the doctor better through the iPad, and we hadn’t realized how muffled our voices sound through PPE. It’s hard on elderly people and those with hearing loss. They appreciated being able to read our lips and see our emotions.
It’s important to point out that some patients are too sick to benefit from virtual care, and that tele-rounding should not completely replace face-to-face visits. Hospitalists should always call for in-person backup when appropriate based on the severity of illness or disease progression.
“Tele-rounding could provide a lasting solution to our variable volumes. And while no one wishes for a pandemic, we might never have considered it otherwise.”
Gurvinder Kaur, MD, MHA
Based on my experience, I urge hospitals to get an early start on tele-rounding. Don’t wait for the surge to hit. The more proactive you are, the smoother the transition will be. Below are recommendations to ensure the successful incorporation of tele-rounding into your inpatient operations.
- Gain buy-in from C-suite leadership, with the full support of your IT team. IT engagement is needed to support the hardware and software needs of a tele-rounding program.
- Once approved, order the appropriate number of tablets, stands, and other equipment. Depending on procurement practices, fulfillment can take weeks, so don’t delay.
- Create training manuals and conduct online and in-person training modules for all affected staff.
- Perform a dry run with physician and nursing teams to test hardware, software, algorithms, and logistics. Do this at least once before you officially roll out in your practice.
- Engage your nursing staff. Connect daily with RNs and create an appointment schedule for patient rounding that’s aligned with the RNs’ schedule.
- Be prepared to tele-round at other affiliated hospitals and ancillary sites. One of the biggest benefits to telehealth is that care is no longer limited to the four walls of the hospital.
The benefits of tele-rounding more than justify the investment:
- Reduction in PPE: By caring for patients remotely, clinical teams don’t need to don masks, gloves, and other equipment for a quick visit.
- Greater protection and safety: Providers reduce the number of potentially contagious patients they see in person. Patients benefit from less physical exposure to care teams while still receiving quality care.
- Optimized clinical workflows: User-friendly platforms connect clinical providers; improved utilization of standardized protocol-driven care saves time and energy. Documents, X-rays, and other medical records can also be easily and securely shared.
- Improved nursing workflow: It takes the guesswork out from their day about the time of the physician rounds. They can communicate an accurate time window of the physician rounds with individual patients and be prepared with their specific needs and questions.
I strongly believe that tele-rounding could solve some of the perennial problems facing our hospital long after the pandemic passes. In recent years, our census has been unpredictable. And as a small, rural hospital, we sometimes find ourselves scrambling to staff up. Tele-rounding could provide a lasting solution to our variable volumes. And while no one wishes for a pandemic, we might never have considered it otherwise.