PMC:7272163 / 2306-8965 JSONTXT

{"target":"http://pubannotation.org/docs/sourcedb/PMC/sourceid/7272163","sourcedb":"PMC","sourceid":"7272163","source_url":"https://www.ncbi.nlm.nih.gov/pmc/7272163","text":"The Emory Palliative Care Center, part of Emory University, provides in-patient consultation service at nine hospitals which include a wide range of settings from quaternary academic to community hospital settings. The inpatient telemedicine palliative care consultation workgroup convened on March 19, 2020 to develop a standard process enabling e-family meetings (Table 1 ) and a goal to develop a workflow that could be replicated at each of the nine facilities served by the Emory Palliative Care Center. We identified Emory University Hospital Midtown (EUHM) as the initial pilot location. The team sourced the necessary equipment, which included a tablet device with built-in speakers that could provide adequate sound (iPad, Apple, Inc., Cupertino, CA) that deployed Zoom (Zoom Video Communication, Inc., San Jose, CA) for a multiway audio-video interface at the originating site (patient's room). The palliative care clinician used another tablet at the immediate distant site (outside the patient's room), and family members connected via Zoom loaded on their own device(s). One member of the workgroup was responsible for the training. First, we trained all providers (8) at the initial pilot site, EUHM. For the remaining facilities, we identified one to three champions at each location and employed a train-the-trainer model. Over the course of several days, the trainer then went to each of the remaining practice sites and provided a hands-on demonstration of the steps for conducting an e-family meeting (Table 1). Subsequently, the champions then provided training of other team members at their respective practice locations. The primary trainer remained available to all of the sites and checked in periodically with each location to provide further coaching and seek feedback from end-users.\nTable 1 E-Family Meeting Procedure\nKey Steps Pearls and Helpful Phrases\n1. Identify a single point of contact for the family and schedule the meeting • Coordinate with bedside nurse to set meeting time that aligns with anticipated nursing or respiratory patient care schedule. This also provides meaningful opportunities for other care team members to engage with patient's family.\n• Confirm planned meeting time allows for participation of necessary or interested care team members (e.g., ICU team, social worker, chaplain, other consultants)\n• Identify and call single point of contact for the family and obtain their email address.\n• If care decisions need to be made, confirm that the necessary legal surrogate/s will be available to participate at proposed meeting time.\n• Schedule meeting and generate an email link.\n• Share link with invited care team members.\n2. Provide meeting link and instructions in email to family • Email Zoom link with the family point of contact, instruct them to share the link with anyone that they want to have join the meeting.\n• Email Zoom links for both audio only and audio/video participation to allow participation of individuals who lack Internet access.\n• Send email link from a protected and unmonitored email address with disclaimer that email address will not be used for further communication.\n• “Please write down any questions you have about your loved one's care before the meeting so we can be sure to address all your concerns.”\n• “Please join 10–15 minutes before the start of the meeting to ensure all technical difficulties may be addressed”\n• “Please find a quiet environment for participation, during the meeting we ask that you stay on mute unless talking.”\n3. Plan entry, “donning” and positioning of the tablet device • Place the tablet in a plastic disposable sleeve cover (no-sterile paper sheet protectors) ensuring that the tablet speaker is at the open end of the plastic sleeve to optimize sound.\n• Place tablet in the stand on bedside tray table and position to ensure patient is in view.\n• If patient is not able to participate in meeting, mute audio on tablet to prevent meeting disruption due to alarms and monitor sounds in patient room.\n4. Start the E-Family Meeting • Set an agenda sharing what you hope to cover and invite the family to add items to the agenda.\n• “We want to make sure that you have a meaningful visit and that this encounter meets your needs. From our perspective, we would like to provide a clinical update and answer any questions you may have and then allow a virtual visit. Are there any other items you would like to add to our agenda today? We have total of about X minutes.”\n• Notify/warn the family before the patient appears on the screen what they will see.\n• “For some people it's helpful to see their loved one by video when they are unable to see them in person; for others, it is not helpful. If you find the images disturbing, you can simply turn away from the screen or place your phone or tablet face down.”\n• Provide guidance that the video content maybe upsetting to children or others.\n• “If there are children who may be present, we recommend that their parents or other adults view first and use their discretion if it is appropriate for children to view the video as well.”\n• Discuss safety ground rules: no driving.\n• “Your safety is important to us, we will begin the meeting when you are able to bring your car to a stop and in a safe location”.\n5. Conducting the e-family meeting • Ensure proper introductions of the team and family—can be larger than typical in-person meeting\n• Allow for patient to speak\n• Address as many people on video as possible\n• Mute participants that are disruptive if necessary\n6. Offer a virtual visit • When able, allow time for family to have a visit with patient\n• “We are going to allow you a private virtual visit with X, we will mute our audio and video, and we will check in with you in about x minutes, please take this time to visit. We will let you know when we have about two minutes left.”\n• For patients at end of life encourage participants to “please take this time to say whatever is in your heart.”\n• Offer opportunity to allow for spiritual practices, prayer, or music; invite available spiritual health clinicians or chaplains to facilitate this portion of the meeting.\n7. Ending the meeting • Give a two-minute warning\n• Use a timer verbal countdown to end – “this meeting will end in 10 seconds … 10, 9, 8, 7 …. ” Then shut the video off.\n8. Recover, “doff,” and clean the tablet and stand • Coordinate tablet removal preferably with available care team member who has patient care need for PPE and entry into room\n• Doff the tablet from the protective sleeve and clean the device and stand with sanitizing wipe\nSuggested communication phrases are represented in 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