As many patients and providers have seen throughout the COVID pandemic, virtual visits are fundamental to a successful telehealth program. For patients, virtual visits allow for real-time, face-to-face communication with their providers, be it their PCP, home care nurse, or a specialty care provider. For clinicians and healthcare organizations, virtual visits are both time efficient and cost effective. However, many clinicians are uncertain on how to implement virtual visits into their patients’ care plans or how to conduct a virtual visit.
Virtual visits can be leveraged in several ways, including for scheduled visits and for PRN visits, and can be utilized by multiple providers, including home health nurses, physical therapists, occupational therapists, and social workers. For the purpose of this blog, we will focus on overarching best practices that can be applied across disciplines and best practices for skilled nursing telehealth visits.
Benefits and Goals of a Telehealth Visit
Virtual visits hold multiple benefits for patients, providers, and for caregivers. As previously mentioned, patients benefit greatly from the face to face communication that telehealth visits offer, enhancing their engagement and relationship with their providers. This personal form of communication can help ease patients’ nerves and offer reassurance when needed. In addition, many telehealth platforms, including HRS, enable patients to initiate virtual visits with their clinical team should they feel their symptoms have exacerbated and their condition has worsened.
For providers, telehealth visits produce both time and cost savings through increased efficiency, reduced windshield time, and reimbursement opportunities. When paired with remote patient monitoring, telehealth visits enhance patient assessments, enabling clinicians to identify and mitigate exacerbations that may otherwise cause a hospitalization. Finally, telehealth visits provide clinicians with an additional avenue through which they can teach patients and help them establish symptom self management skills.
Though goals of a virtual visit may vary slightly across providers and for scheduled versus a PRN, there are several key goals to keep in mind when conducting a telehealth visit:
- Enhance the patient’s plan of care
- Engage the patient in their care plan and self-management
- Assess the patient’s current status
- Identify new or worsening problems
- Identify improvements and reinforce positive behavior
- Answer the patient's questions
Basic Best Practices for a Telehealth Visit
- Make Eye Contact: Check your camera or practice prior to the call to ensure the camera level and image quality are sufficient.
- Ensure the Patient Can Hear: A microphone and headset can drastically improve the sound quality of a telehealth visit, but be sure to ask the patient if they can hear you. You should also look for recognition in the patient to guarantee they’re hearing and following your discussion.
- Reintroduce Yourself: Chronic care patients have multiple providers and aspects to their care plan; be sure to reintroduce yourself.
- Take Your Time: Schedule enough time with the patient to achieve all your goals for visit; include time to talk to the patient and answer their questions.
- Leave Time for Questions: Take your time running through your evaluation and questions for the patient, and also provide ample time for patients to ask any questions about their care plan or the technology.
- Find a Private Space: Be prepared to provide the patient with your undivided attention. Many providers have a dedicated space for clinicians to perform telehealth visits.
- Follow-up Before the Call: Call or text the patient the day before their telehealth visit to remind them of the upcoming appointment. Many HRS partners will call the patient prior to the virtual visit to ensure they are awake, dressed and ready for the call.
- Prepare for the Call: As with an in-person visit, review the plan of care, recent vitals and trends, teaching performed, medication, and any notes or follow-up from previous calls.
Take it to the Next Level
- Introduce Patients to the Technology: During the installation visit, review telehealth visits with the patient, including the purpose, the benefits, and the technology. Demonstrate how the patient should position the tablet and answer a call. Finally, have the patient complete a practice visit while you’re there to assist.
- Check Network Connectivity: We recommend reviewing connectivity during the installation visit. If connection is poor, connect the patient’s tablet to WiFi for improved connection.
- Explain the Purpose of the Visit: After you reintroduce yourself to the patient, explain the purpose of the visit. Explain what your goals are as a clinician and what your goals are for the patient during and following the visit.
- Coordinate Across Providers: Chronic care patients have multiple providers contributing to their care. Coordinate with providers to ensure the patient’s visits aren’t scheduled for the same day which can overwhelm the patient. Instead, spread visits throughout the week.
- Teach and Teach-Back: When asking patients how they’re feeling or what zone they are in? Ask them to explain why. This allows patients to demonstrate their understanding and allows clinicians better insight into the patient’s progress surrounding self management.
- Ask open-ended questions: Increase patient engagement and improve information provided through open-ended questions. Rather than asking, “did you take your medications today?” which can lead to incomplete answers, ask the patient to explain “what medication have you taken today?”
- Offer Positive Reinforcement: When learning to manage their symptoms and conditions, chronic care patients are given countless tasks which can be daunting and cause frustration or a feeling of helplessness. When patient vitals progress, symptoms subside, education or understanding is demonstrated, or other improvements are made, reinforce that behavior. Let patients know they’re on the right path.
- Note appearance and demeanor: A key benefit of a telehealth visit is the visual aspect. Take advantage of the ability to see patients to note their physical appearance. Does the patient look tired, are they focused on you, what do their surroundings look like?
- Documentation: Complete immediately following call, including notes of education provided, observations on patient appearance and demeanor, and more. This will help inform you and other providers when preparing for the next visit.
The significant increase in virtual care during the course of the COVID-19 pandemic paved the way for greater adoption of the practice among both providers and patients, a paradigm shift that is here to stay. A successful virtual visit program includes a well developed, well thought out process and a keen understanding of how to engage patients in a meaningful way. Virtual care is a clinically effective and efficient component of patient care.