Can You Hear My Empathy? Rapid Implementation of a Pediatric Palliative Care Virtual Visit Initiative during the COVID-19 Pandemic

Abstract

Background: Physical distancing required during the COVID-19 pandemic mandated a sudden need to adaptour usual practices for palliative care patient encounters Adopting virtual visits (VV) may present challenges inmanaging new technology, establishing rapport, discussing difficult topics, and may diminish patient, familyand clinician satisfaction Problem statement: Pediatric palliative care clinicians have never performed virtualvisits We worry that this mode of health care delivery would negatively impact care quality and patient andfamily satisfaction AIM: By June 1, 2020, we aim to have patient/family and clinician satisfaction score of > 4 ona 5-point Likert scale for >80% of completed VV encounters Methodology: This project was granted IRB exemption We used the model for improvement to ask thefollowing questions: What are we trying to accomplish? Shift of inpatient and outpatient workfiow to includeVV How we will know a change is an improvement? Family and clinician satisfaction surveys What change can we make that will result in improvement: Several changes were considered and summarized in our Key DriveDiagram (KDD) ( Fig 1 ) Measures: We measured family satisfaction score by asking “How well did this visitmeet your care needs compared to an in-person visit?” with responses on a 5-item Likert scale We measuredclinician satisfaction with an identically modeled survey In later PDSA cycles, we gathered qualitative datafrom families and clinicians The response rates to family and provider satisfaction surveys were used as theprocess measure;balance measures were RVU collected for virtual visits and assessment of staff satisfactionwith VV workfiow Discussion: We adopted weekly PDSA cycles Given the need for a rapid shift in caredelivery, interventions to set up technology and train staff on use of technology were made prior to obtainingfamily feedback Interventions are summarized in KDD ( Figure 1 ) At the end of three PDSA cycles, 33% offamilies and 63% of all providers responded to surveys 100% of families and 57% of clinicians rated VV asequivalent in quality to in-person visits Qualitative feedback from clinicians indicated greater emotional tolland increased fatigue with VV We plan to report data over a six-month period as both inpatient andoutpatient palliative care VV continue Conclusions/Next Steps: We have demonstrated the ability to rapidlyadapt palliative care visits to a virtual platform while maintaining patient and family satisfaction whencompared to in-person visits As in-person visits again become possible, we will continue to survey cliniciansand families to better compare satisfaction between the two visit types and develop a sustainable workfiowintegrating effective VV (Figure Presented)