Table 1.

Qualitative results by theme and subtheme and example quotes.

Theme and subtheme		Quote
Implementation setting and climate
	Adoption	“Great. And who’s using this video chat option? Which types of roles are using it? Is it just attendings? Are residents involved? Nursing? Who else?” (Interviewer) “Yeah, I think everybody is, and I know nurses go in and out of the room too when I’m using it. So, everybody, essentially.” (Attending physician #2)
	Information sharing and training	“I believe I was told about it at a division meeting and I didn’t receive any formal training in it, but it was easy enough to use without having to go through a training session.” (Attending physician #3)
	Information sharing and training	“What information were you given when this all first launched about how to use the technology?” (Interviewer) “Not a lot. I was told it was available and that most patients with COVID had it as long as they were on the right units. And then that it was allowed in lieu of the physical exam now. So that was sort of the information that we were given.” (Resident physician #2)
Clinical team workflows
	Physician workflow	“Typically what we do is as a team, we’ll go into one of the Zoom rooms and we will call the patient using the video chat. We’ll call in an interpreter if we need, and we’ll do the history taking and a visual physical exam over Zoom. And if the patient is new to me or had a clinical change that requires a physical exam, then after we do the rounding over the video chat, then I’ll go into the room and do any parts of the physical exam that require me to be physically in the room.” (Attending physician #4)
	Nurse workflow	“The organization is really depending on nurses to be solely, I guess the person who’s doing direct patient care most of the time in COVID rooms. Before this there were very few barriers to having physical therapy in the room or consulting teams doing their assessment and chatting with the patient, having housekeeping come in, right? But now we’ve taken over some of respiratory therapy’s responsibilities just to decrease exposure for them and to conserve PPE [personal protective equipment], so we’re doing metered-dose inhalers, et cetera, for them. Housekeeping isn’t allowed into the room except to do discharge. So we’re doing trash and linen for the moment. I mean, physicians will come in if it’s emergent and there are definitely different teams that come in to do their daily assessments, but for the most part it’s solely nursing doing physical assessments and they’re really relying on us to see the changes and advocate for the patients if something is new or if they’re deteriorating, et cetera.” (Nurse #5)
	Nurse workflow	“...in the beginning when the nurse comes in, before she goes in the room, she’ll do a teleconference with the patient to check on them, see if they’re awake, if they’re ready to order breakfast. What do they need before we come into the room, because we’re trying to compile care, kind of do as much as possible when we enter, so we’ll do it in the morning. We’ll bring them the breakfast tray, we’ll get them fresh linen, we’ll get them the morning medicine. So, we’re doing as much as possible when we go in the patient’s room.” (Nurse #3)
	Extended care team workflow	“...You have to first log in with the patient and then you say, ‘Hey.’ I speak Spanglish. I’m like, ‘Hola. Un minuto.’ And then I get the information for the chat, the number and the password, and I text it to the interpreter and then they hop in and some are between five and 10 minutes.” (Attending physician #2) “So in that five- to ten-minute gap, what happens?” (Interviewer) “Yeah, that’s awkward. And if you leave the room then the password changes. So, you have to stay there. I say in my Spanglish, ‘A person’s coming,’ and then we just kind of hang out. But actually, today the patient fell asleep, literally while we were sitting there because I think it took like nine minutes.” (Attending physician #2)
	Technology support workflow	“You mentioned a few things that weren’t going well already, but what else with the Zoom technology isn’t working well?” (Interviewer) “I think those were the main things. Like there were a couple times when it just like, was on pause or out of batteries or something...” (Resident physician #3) “Okay. And who’s actually responsible for maintaining the iPads? Like charging them?” (Interviewer) “I don’t know.” (Resident physician #3)
Clinical team satisfaction
	Physician satisfaction	“For me, it helps the anxiety a lot. I have a young child at home, so related to that, I was really extra worried about becoming sick myself. Once I was actually in the hospital for the first time during COVID and seeing how smoothly things were going with the PPE and everything, I felt a little better already. But then just knowing that I didn’t need to be exposed any more than absolutely necessary. That was very helpful.” (Attending physician #5)
	Physician satisfaction	“So when I was on wards, I never went physically in the room with any of these [COVID-19] patients and in that way I think it’s detrimental...you don't get a lot of the teaching about the physical exam that you probably wanted.” (Resident physician #3)
	Nurse satisfaction	“It’s a little time consuming to be able to coordinate [calls]. [Physicians ask] ‘Oh, can you show me how to Zoom? Can you show me?’, even though we have clear instructions in each of those Zoom rooms, each of the conference rooms on how to set it up, everyone’s like, ‘Oh, can you show me how to do it?’ So, we have to kind of stop what we’re doing if it’s nothing too important and we have to go.” (Nurse #1)
Perceived impacts on patients
	Quality of care	“I think from a like, is the patient getting the care that they need and are they getting better standpoint? The answer is yes, but I do think you lose something by not being able to be physically present next [to] your patient. And that might be something that’s like a, it’s like an intangible, but it’s kind of just like the, having the proximity of being a physician next to you to comfort you or reassure you, which is just different when you’re doing things remotely.” (Attending physician #3)
	Quality of care	“I think it puts a lot of onus on the nursing staff, which is okay because there is clinically a really strong staff, but I just wonder if that is the safest quality of care...That is why I don’t know if it really is good. I mean, yeah. I’m a little bit indifferent about it...I think in certain scenarios, it is really important and probably others, it is probably not. I do think there is potential for something to be missed. I worry, I guess.” (Nurse #4)
	Patient privacy considerations	“Sometimes we would try calling first to ask on the room phone and to ask if it was a good time. Another thing is [the tablet] was angled such that it was at their faces, not anywhere else, and so we felt like it was unlikely that they were going to be kind of like exposing that much of themselves. That was a challenge I don’t think I’ve fully solved.” (Attending physician #5)
	Patient privacy considerations	“I don’t think [privacy]’s an issue at all, and I could see how it’d be a question, but...to be honest with you, if you had to wait for the patient to answer, it just wouldn’t work. Most of the time they’re sleeping, even the middle of day, or they just don’t hear it...So if you needed them to answer the call, then it would only work 50 percent of the time.” (Attending physician #2)
Limitations of inpatient telemedicine
	Communication	“[Researchers] were consenting [the patient] for remdesivir and they used an interpreter. They didn’t go into the room and they used an interpreter via phone and there was still a language barrier where the patient didn’t understand what they were consenting him on. So, he said no to remdesivir... I speak Spanish, so the next day I went into the room and I said, ‘Just a question. Why did you say no to the remdesivir trial?’ And he’s like, ‘I don’t know. I couldn’t really understand what they were saying over the phone, so I just said no.’” (Nurse #1)
	Patient–clinical team connection	“I had one COVID patient where I needed to have a goals of care conversation that really didn’t feel like it was working well over the Zoom, and so I did that in the room. I think I worry a little bit sometimes that if we only see patients over the Zoom, that it increases their sense of isolation and their feeling of fear and feeling... Yeah, their feelings of isolation and fear. And that there’s something to be said for the emotional connection and support that comes from physically being in the room.” (Attending physician #4)
Anticipated future uses of inpatient telemedicine
	N/Aa	“I do think that especially if it were something that we could access from all over the hospital...now that we have a new hospital and our patients are not well co-localized, people spend so much time just walking from place to place. I could see it really being helpful. Of course you want, under normal circumstances, to see every patient in person at least once a day, but if you’re literally a mile away in the hospital and a patient just has a question, it does feel more personal to Zoom in and be able to talk to them where they can see your face...Of course you get more information too, you can see, are they having trouble breathing? Do they look sicker than when you saw them earlier? That kind of thing.” (Attending physician #5)

^aN/A: not applicable; there were no subthemes for this theme.