key: cord-328948-m5h2hgpb
authors: Wang, Hanyin; Poehler, Jessica L.; Ziegler, Jenna L.; Weiler, Chad C.; Khan, Syed Anjum
title: Patient Care Rounds in the Intensive Care Unit During COVID-19
date: 2020-07-04
journal: Jt Comm J Qual Patient Saf
DOI: 10.1016/j.jcjq.2020.06.006
sha: 
doc_id: 328948
cord_uid: m5h2hgpb

nan

Hanyin Wang, MD 1 ; Jessica L. Poehler, RN 2 ; Jenna L. Ziegler, RN 2 ; Chad C. Weiler, RN 2 ; Syed Anjum Khan, MD 2 The situation has posed a considerable difficulty for patient care rounds in the ICU. Multidisciplinary bedside ICU rounds provide a key stage for providers to review patient conditions and communicate a plan of care. Given the complex nature of ICU patients, who frequently cannot make medical decisions, daily rounds are used to engage family in patient care. 1,2 With a visitor restriction policy, families of critically ill patients feel huge anxiety, guilt, and frustration. 3 Families are calling ICU 24 hours a day, crying and wanting information about their loved ones. Another major issue is that families are receiving bits and pieces of information at different times. Sometime they perceived mixed messages especially after shift changes or handoffs. The emotional and physical tone of the COVID-19 epidemic is already a huge burden on the staff. On top of that they feel the needs of families are not met. A creative solution for ICU rounds is needed in the COVID-19 era.

Evidence has shown success of telemedicine for ICU care. 4, 5 Our hospital recently implemented a telemedicine model for ICU rounds that is well perceived by the ICU team and patient families. First, providers with direct patient care (including an intensivist physician, midlevel provider, nurse, and respiratory therapist) perform bedside patient evaluations separately before rounds. Second, all care team members (including a pharmacist, nutritionist, physical therapist, speech therapist, social worker, charge nurse, and e-ICU) call in to an encrypted video conference system at a standard time. The patient"s pre-appointed family member is connected into the conference through a different phone line. Third, telerounding is led by a physician following the usual rounding process where the patient"s nurse summarizes overnight events and goes over the ICU checklist, followed by each participant giving their recommendation. During virtual rounds, a dedicated staff is assigned to review electronic medical records for any questions and place new orders. Family stays on the line for the entire rounds for their loved one, which usually takes 10 minutes. For families with limited English proficiency, a real-time interpretation service is utilized for communication. In the end the physician summarizes key information to the family and answers their questions. If questions remain or other concerns arise, the provider calls the family after rounds. A sample ICU daily rounds scripts is provided in the appendix.

As a next step, we plan to engage patients in the rounds as appropriate, using a robotic telepresence system. Another novel use of the ICU rounds being explored by the ICU team is student clerkships which were cancelled during the epidemic. 6 This is greatly impacting education for medical students. We are exploring the possibility of providing medical student participation during ICU rounds, which would be a huge learning experience in critical care and management of COVID-19 patients. In this challenging time, we hope experience from our center helps the international critical care community to plan for an effective rounding strategy using telemedicine.

The authors have no conflicts of interest.

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