A new telehealth quality improvement program designed for skilled nursing facilities can help maximize the amount of total rounding time spent on patient/resident care and reduce nonclinical time devoted to troubleshooting, according to geriatrician-researchers.

The project, developed by physicians with Presbyterian Intercommunity Hospital in Whittier, CA, and University of California, Los Angeles, Health, identified common telemedicine-related disruptions and their solutions, and then created a virtual rounding improvement protocol.

The study included 413 telemedicine encounters in two Los Angeles SNFs from April 2020 to January 2021. Participants included 66 residents — 15 long-term custodial and 51 post-acute individuals. Both facilities experienced COVID-19 outbreaks during the study.

The most common causes of telemedicine delays were staff members’ lack of familiarity with the technology, not having the necessary equipment or staff at bedside during rounds, and WiFi connectivity issues, the researchers reported.

The study team created an optimized workflow and then spot-checked telemedicine rounds over the following nine months, repeating efficiency measures to assess their sustainability, according to Susan D. Leonard, M.D., and colleagues.

Summarized recommendations:

  1. Meet with the nursing home administrative and clinical team to determine feasibility and establish protocols.
  2. Technology:
    • Use a HIPAA-compliant video platform.
    • Have IT adjust WiFi bandwidth to prioritize the tele-video platform.
    • Choose a device with a large screen: a device with front- and back-facing cameras are ideal for skin and wound examinations.
  3. Coordinate a rounding time with nursing home staff work schedules in mind.

“In a time when the workforce is strained due to limited resources, streamlining the telemedicine process in nursing homes is vital in providing high-quality healthcare to vulnerable populations,” the researchers concluded.

Full findings and detailed recommendations were published online ahead of print in JAMDA.