Perception and Acceptability of Virtual Ward Round Reviews of Vascular Inpatients to Preserve Resources and Reduce Infection Risk in the COVID-19 Era

COVID-19 has created a significant global challenge within hospitals to limit the spread of disease.¹ Recent studies have shown that those who acquire the infection peri-operatively have worse outcomes, particularly when considering vascular disease populations.² In addition, healthcare workers themselves are at high risk of infection. Reports suggest that almost 40% of asymptomatic workers test positive for COVID-19, highlighting the importance of social distancing to reduce infection transmission by asymptomatic carriers.³

In response to the pandemic, the Royal College of Surgeons of England has published recommendations for overcoming these challenges, suggesting service reconfiguration and engagement with virtual technologies. At our vascular centre, we responded by trialling a virtual ward round (VWR) to limit consumption of personal protective equipment (PPE) and improve social distancing. Prior to this, our standard vascular inpatient ward round (SWR) consisted of an eight person multidisciplinary team (MDT) led by the consultant of the week.

During a SWR, around 60 patients would be assessed daily with live access to all relevant information including plans from the patient's primary consultant. The MDT includes personnel from podiatry, pharmacy, and therapies to allow efficient real time decision making and maintains clear communication between teams and patients. Although other centres within the UK use similar models, practice will inherently vary nationally and internationally. While component MDT members may operate more independently elsewhere, their individual face to face patient contact commonly remains a daily occurrence.

In contrast to the SWR, the VWR system consisted of a three person ward team with only the lead surgeon carrying out face to face consultations. They were supported by a remote team of all the remaining MDT members off the ward, providing continuous relay of information and opinion from isolated satellite workstations throughout the round.

Live communication between teams was maintained using conference calling over hands free headsets connected to hospital encrypted Wi-Fi. After trialling the VWR for a month while patients positive for COVID-19 were being cared for throughout our hospital, patient and staff surveys were circulated and the SWR and VWR results compared using the non-parametric Mann–Whitney U test.

The survey provided 21 staff and 31 patient responses. Following transition to the VWR, observed physical staff numbers on the ward round fell 60%, from a median of five (interquartile range [IQR] 4.5–6) to two (2–3) per ward round (p < .01). Similarly, when excluding the lead consultant, who maintained usual patient contact on the VWR, face to face staff patient contact reduced by 83% from a median of 15 (10–30) to 2.5 (0–15) per day (p < .05). Contact between staff members also fell with the VWR, reducing by 33% per day.

Staff survey results showed a preference towards the VWR over the SWR across all considered domains of organisation and safety, efficiency, communication, and information availability. Specifically, perceived infection risk, space utilisation, and efficiency of the ward round and PPE usage were significantly improved with the VWR (Fig. 1 ). The latter is of particular importance in view of the huge global demand for these scarce resources in these circumstances.⁴

Figure 1.

Comparison between staff impression of the virtual ward round (VWR; dark grey) vs. standard vascular inpatient ward round (SWR; light grey) for various components of the ward round during the COVID-19 pandemic. ∗p < .05, ^†p < .01 (Mann–Whitney U test).

Despite prior concern regarding the ability to provide adequate training with a VWR, 75% of staff still reported receiving “good training” and greater satisfaction with the VWR approach (Fig. 1). There has been increasing use of technology in medical education over recent years and we believe these techniques could be integrated with our own VWR system to further enhance future training experiences when student clinical involvement restarts in the near future.⁵

Results of the patient survey revealed that over 90% of patients felt there was less infection risk and safe standards of care were maintained with the VWR. The majority of the patients felt that they remained central to the ward round, preferred fewer personnel being physically present, clearly understood their care plan, and consequently rated the VWR highly. This is despite only half of those surveyed agreeing they were comfortable with the use of virtual discussions.

One of the study limitations identified was the inability for the remote team to visualise patient wounds. Live video or access to confidential, encrypted mobile image sharing applications would potentially resolve this issue. Unfortunately, current freely available mobile applications providing these services fail to meet required security standards for use within our system. These initiatives require significant investment and a robust clinical governance framework prior to their implementation.

The VWR is a reproducible and innovative approach with potential to mitigate the risk of COVID-19 spread and preserve resources. The early results of this pilot study appear to indicate this approach to be safe, efficient, and satisfactory for patients and healthcare professionals alike. This work could form the basis of a larger prospective study to confirm the initial findings and develop the system further with video capability, analysis of the economic impact of staff illness and resource use, and finally, the effect on infection transmission within hospitals.

Conflict of interest

None.

Funding

None.