In the early days of the COVID-19 pandemic, New York Presbyterian Weill Cornell Medical Center and Lower Manhattan Hospital faced multiple challenges during the first COVID-19 surge.
Innovators within AHRQ’s Patient Safety Network Program https://psnet.ahrq.gov realized there wasn’t enough staff to meet patient care needs. Also, they realized that several providers’ needed to work at home during the pandemic, several hospitalists needed to stay offsite due to pregnancy, comorbidities, quarantine due to COVID exposure or were recovering from illness. However, some of the staff was available to work virtually.
The innovation team decided to include a telehealth model where virtual intensivists can work together with in-person non-intensivist providers using a software engineering model. The model is needed to train 15 experienced hospitalists to work virtually to support onsite clinicians.
After the virtual hospitalists are trained, they were able to address patient and family communication, write clinical notes, and train redeployed physicians. Virtual hospitalists conducted rounds with a paired onsite hospitalist and communicated via speakerphone or tablet. While the virtual hospitalists conducted chart reviews and paperwork, the onsite hospitalists focused on physical exams and patient treatment.
Virtual hospitalists’ duties included remotely reviewing medications, lab results, and vital signs. They also assisted with planning, executing clinical care, and focused on communicating with patients and families. To account for the fact that they were not onsite and treating patients in person, the virtual hospitalists were compensated at two thirds of their normal rate.
According to the innovation team, smooth implementation of this initiative requires teamwork, adequate staffing resources, technological resources, leadership buy-in and support, team member flexibility, plus a clear explanation to onsite team members on why some of the staff was working virtually.
The innovation team notes that it is important to ensure there is the necessary technical infrastructure to support the program and enable onsite and offsite clinicians to communicate. It is also important to secure leadership support, enable staff to be flexible and collect data to show the potential impact if possible.
Go to https://ahrq.gov/innovations for the Report: A Virtual Hospitalist Program to Address a Hospital’s Challenges at the start of the COVID-19 Pandemic