Background
The COVID-19 pandemic has affected neonatal intensive care unit (NICU) care in many ever-changing ways, due to insufficient current knowledge of the disease process and the public health effort to decrease spread. Starting in March 2020, hospital-wide visitor restrictions due to the COVID-19 pandemic made it challenging for families in the NICU to see their infants and for medical providers to provide face-to-face updates. In an effort to provide families with consistent updates on rounds in the face of changing visitor policies, we implemented a virtual rounding (VR) workflow using telephone and video communication devices. This project is also a part of a unit-wide quality improvement initiative to improve family engagement.
Objective
The primary aim of the project is to increase family participation in rounds from a pre-COVID-19 baseline of 10% of the daily census to 40% of the daily census by April 2021. Family participation is averaged on a weekly basis. The sub-aim of the project is to increase video or telephone family participation in rounds from 0% to 30% of the daily census by April 2021.
Design/Methods
This is a quality improvement initiative using the Plan-Do-Study-Act (PDSA) methodology at the University of Massachusetts Medical Center's 49-bed, level III NICU. A multidisciplinary quality improvement team was created from the NICU's Family Engagement Committee consisting of physicians, nurse practitioners, nurses, child life specialists, and parents of former NICU graduates. We identified key drivers to reach our aims with focus on establishing buy-in and workflow for virtual rounding. PDSA cycles were established for multiple proposed interventions, which included trialing tele-health resources, disseminating rounding information to families and collecting their contact information, creating a workflow for contacting families during rounds, and establishing a system for documenting family participation in rounds for data collection purposes.
Results
From the time of implementation of virtual rounding in mid-May to the end of November, the weekly average percentage of families participating in rounds either in-person or virtually increased from a pre-COVID-19 baseline of 10% to 28%. Virtual rounding, initially via video and telephone calling and eventually transitioning to telephone calling only, played a significant role in increasing the percentage of families participating in rounds.
Conclusion
The implementation of a virtual rounding workflow increased family participation in daily rounds in the NICU in the face of changing visitor restrictions due to the COVID-19 pandemic. Our next steps include addressing family preference regarding mode and frequency of contact from the NICU team, increasing family participation prior to maternal hospital discharge, identifying limitations to staff buy-in and workflow, and assessing the effect of increased frequency and regularity of updates on family experience.
