Video visits as a form of family visits in the hospital are slated to continue, some experts assert, as a key method for driving patient satisfaction.
By Sara Heath
– At the onset of the COVID-19 pandemic, clinicians at Orlando Internal Medicine were faced with an impossible situation. The organization was going to have to shut down family visits for the sake of patient safety, but leadership knew this was going to tank patient satisfaction.
“We deal with some really sick patients and we had to shut everything down overnight,” Pradeep Vangala, MD, an internist at Orlando Internal Medicine, told PatientEngagementHIT. “It was a very difficult decision, both for us and our patients, as well as families who could not see the loved ones. And then we had a big problem. More of a consequence of that, which is inability or difficulty communicating with family members, which obviously is a really important aspect of the patient care, so that got severely interrupted as well.”
Vangala and his team at Orlando Internal Medicine, which treats patients across the care continuum from acute settings to long-term care to outpatient practice, were not alone in this decision. Data shows that most organizations had to make some sort of change to their family visitation policies as part of the COVID-19 lockdown in March.
Per figures in Michigan, nearly every organization made at least some type of change to family visitation policies. Some organizations limited visitors to only one family member and for only certain types of visits, while others implemented a tight family visitor lockdown.
Anecdotal evidence shows that this was the story across the country, including in Orlando. Vangala and his team began with a strict prohibition on family visitors before opening up to only one visitor per patient. Now in November, Orlando Internal Medicine allows more visitors who are subject to coronavirus screening, donning of face coverings, and restrictions within the physical space of the organization’s hospitalist groups.
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But in the beginning, these family visit shutdowns were deeply upsetting for everyone, Vangala said.
“I remember family members would come and visit their families, especially the ones that are there on the first floor, and would literally come and visit the family members through the windows,” he recounted. “But all this comes from the concept of zero harm. You don’t want to do anything that in any way would harm the patient. That is of paramount importance.”
“But it was very heartbreaking and we were really hoping that we could start the family visits back as soon as we could,” Vangala added.
The boom of telehealth would prove to give Vangala and his team the respite they’d been hoping for. Just as video visits were proving essential in continuing patient access to care at the onset of the pandemic, they would also be helpful in connecting patients—and their clinicians—to family members and loved ones while the organization’s doors remained closed.
“If there is a silver lining to the whole COVID-19 pandemic, it’s the advancement in medical technology and the telemedicine platform. COVID-19 really acted as a catalyst,” Vangala said. “And that way we’re very happy because in the short run, we were able to still connect with family members, get patients to connect with family members.”
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The team at Orlando Internal Medicine leveraged its telehealth platform to conduct video visits between bedridden patients and their disparately located loved ones. The organization had several iPads they would issue across the hospital, and staff members helped patients log onto the technology and visit with their family members.
This went a long way in improving the patient experience, Vangala noted, because visits with family members naturally serve as a mood-booster.
But it was also a good thing for quality of patient care, he added.
“A lot of times, if I know that my patient’s family member is going to be there on the phone, I would use that opportunity to go into the room, discuss with the family and the patient on that phone conference as to what’s going on with the patient and the care,” Vangala explained. “And that would be done on a regular basis. We would at least do it about every other day.”
This strategy has followed a similar trajectory to Orlando Internal Medicine’s work with telehealth. Prior to the pandemic, telehealth use was not quite as popular among Vangala and his colleagues, but once the virus forced clinic doors shut, it became their lifeline. Although Orlando Internal Medicine has since reopened its doors, Vangala said telehealth is still playing a significant role, thanks in large part to a streamlined digital platform from Andor Health.
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“We would really want a virtual visit platform that mimics a true office visit expedience for the patient,” Vangala said. “And what do I mean by that? The patient at the time, as they get close to the visit, normally you would get in touch with the patient and say, ‘Hey, your visit is coming up.’ Then the patient gets a chance to be able to make any changes through the demographics intake forms. And when patients come in they check in with the receptionist, sit in the waiting room, go to the exam room and wait for the provider and then check out.”
Vangala’s telehealth solution enables that and mimics that entire step-by-step process. Patients receive intake forms and fill them out with the assistance of a bot, similar to working with the registration desk inside the clinic.
When it comes time for the telehealth appointment, the patient checks in with Vangala’s medical assistant over a video visit. And from there, Vangala himself meets with the patient for the physical exam. Using that same bot, Vangala can call up the patient’s medical record and share the screen to collaborate with the patient.
“So the patient is really going through the entire visit like they’re going to a regular office visit and you have the bot, which is assisting me throughout,” he pointed out. “So that is how we’re doing visits right now. And that has really transformed the way we care for our patients. Patients living far away, patients’ inability to drive—all those things, we’ve tackled them in just one go.”
It’s for that reason Vangala agrees with much of the rest of the medical industry that telehealth is here to stay, at least partially. Telehealth has been a boon for patient access to care during the pandemic and has helped Vangala overcome of the biggest access barriers he saw pre-pandemic.
“Yes, I want to see my patients,” Vangala acknowledged. “A lot of my patients I’ve known for such a long time. In the pre-COVID days, every time they’d come, I would get at least a dozen hugs a day. And so I certainly don’t want to give up on that, putting my arm around the patient’s shoulder. But having said that, there’s a lot of patients that have difficulty coming in, family takes time off. So the technology we have today is going to truly enable that level of virtual visits that we have never had before.”
He has a similar opinion about family video visits, he said.
“So COVID I’m sure with time will die down and things will get back to normal. But this new normal of being able to communicate with family members on a video conferencing chat is something that I believe is here to stay,” Vangala asserted. “There will be those visits in person, but those video-chat visits are going to be there.”
“I’m able to pull up the lab work,” he concluded. “That family member is actually able to see it. The mom may be in Florida, but the daughter is somewhere in New York or Boston, and is able to look at those lab results and X-rays along with me in real time and be able to better understand what’s going on with their loved one.”
