6 telehealth tips for providers

For many providers, the COVID-19 pandemic has accelerated the use of telehealth to serve patients and families. With that, this may be a developing skill set for many physicians and advanced practice professionals. Here are a few tips to ensure a successful video visit:

Determine if the patient is a good telehealth candidate

It’s up to each clinician to gather enough information to make appropriate medical decisions. Refer the patient to in-person care if you determine a video exam is not adequate to provide high-quality medical decision-making.

Here are some things to consider:

  • Is the patient in a private location? Do not provide telehealth services when a patient or parent is driving or in a public location.
  • Does the patient or family have access to the internet and a computer or mobile device?
  • Do you have a medical license for the state in which the patient lives? Restrictions during COVID-19 have been waived but this may change.
  • Is the patient and family able to help with the physical exam, testing and vital signs, if necessary? For example, do they have a thermometer and scale? Are they able to count respirations?

Prep your virtual exam room

Take a few steps to prepare your environment for an optimal video experience:

  • Check for clutter and any personal health information visible in the camera frame. Consider activating the virtual background if necessary.
  • Check your self-view and make any needed lighting adjustments so your face can be seen clearly.
  • Be aware of the position of your devices. If you’re using two screens, ensure they are positioned optimally so you can look back to the patient frequently when documenting.
  • Shut your door, if possible, and hang a sign indicating a video session is in progress.
  • Once the visit begins, be mindful that any typing from charting or notetaking will likely be picked up by the microphone.

Perform some housekeeping

Once the session begins, you’ll need to start with a few housekeeping matters:

  • Verify you are with the correct patient and family by using two patient identifiers such as full name and date of birth.
  • Obtain consent for the telehealth visit from the patient and parent.
  • Explain to the patient and family that the video visit is not recorded, meets HIPAA requirements, and cannot be posted or forwarded.

Ensure comfort and privacy

For both the provider and patient, this visit will certainly “feel” different than a typical encounter. Acknowledge that to the family and then take some steps to increase comfort:

  • Your usual techniques to connect with families can translate well on video. For example, help your patient warm up by asking them to show you their favorite toy or book.
  • To help the family feel more comfortable – particularly if the exam will require clothing to be removed – ask non-essential staff and family members to leave the respective rooms.
  • If others are in the room, introduce everyone in the location. Ask the family to do so as well for anyone who is in the room but off camera and in the microphone’s range.

Double down on communication

Communication is always important – but doubly so during a video exam. Be engaging and encourage cooperation from the patient and parent throughout the exam:

  • Be comfortable giving the patient and family direction to improve the experience. This could mean asking them to adjust lights; move closer or farther from the camera; remove objects obstructing your view; or speak more loudly.
  • Let the patient and family know they may hear you typing but this is because you want to accurately document the visit.
  • Make eye contact with your camera, not the patient’s eyes.
  • Do not cover your camera or mute your microphone; this could make the patient and family feel you’re not giving them your full attention.

Ask for assistance from the patient and family

In the absence of physical proximity, you might need the patient and family to help you perform exam maneuvers:

  • Direct them to remove clothing, as necessary, and remember to tell them when it is OK to put on their clothing again.
  • Tell them how to palpate to localize pain.
  • Explain how to perform range of motion maneuvers.
  • Describe the landmarks you use in clinic to find the right location for an exam component, such as ribs or the pelvic bone.
  • Watch carefully and ask them to repeat anything that appears questionable.
  • Verbalize what you think you are seeing, allowing the patient and their parent to clarify as needed.

Find more resources for telehealth services.

Mental health resources to share with patients, families during COVID-19

For many providers, the COVID-19 pandemic has prompted a flurry of tough questions from patients and their families: How do I explain this to my children? How do I help my child understand why their birthday party is canceled? How do I maintain normalcy while my child is out of school and stuck at home?

If you’re also fielding these questions from worried caregivers, this compilation of resources from CHOC Children’s — with more to come — can help address these questions and more:

Helping kids cope with COVID-19 stress

How to teach kids resilience throughout COVID-19

How parents can cope with COVID-19 stress

Establishing structure and routine for kids during COVID-19

Activity ideas for kids during COVID-19

7 ways to help reduce Coronavirus (COVID-19) anxiety

How to talk to kids about disappointment during COVID-19

Kid-friendly mindfulness and meditation strategies to cope with
COVID-19

Find more information to share with patients and families about COVID-19 at choc.org/coronavirus.

CHOC nurses join pediatric “Hack-a-thon”

Hacking and pediatric healthcare might be an unlikely pairing – but a recent event combined the two, drawing a range of multidisciplinary experts, including six CHOC Children’s nurses, together to create disruptive solutions for pediatric and neonatal healthcare.

Clinicians, physicians, engineers, data scientists, designers and entrepreneurs gathered at the three-day “Hack-a-thon,” hosted by MIT Hacking Medicine and the Innovation Institute at the Innovation Center in Newport Beach, to develop tech solutions and fast-track development of value-driven concepts.  

The CHOC Nursing Research and Innovation Council helped to facilitate nurse involvement in this event, held Feb. 7 to 9. Six nurses actively participated on separate interdisciplinary teams: Donna Bigani, Erin Rentch, Pernilla Fridolfsson, Kylie Castro, Wanda Rodriguez and Jennifer Hayakawa.

The team led by Kylie won second place and $750 for their innovation related to improving the care of patients with autism spectrum disorder.

“The process was nerve-wracking and very tiring, but at the end of the weekend it was completely worth it and an amazing learning experience,” Kylie said. “It was so interesting stepping into another world, learning to speak another language – or what felt like another language – and being pushed outside my comfort zone.”

Several CHOC specialists as well as other staff also participated in the event.

Learn more about nursing research at CHOC Children’s.

Coronavirus (COVID-19): what providers should know

The spread of Coronavirus (COVID-19) is changing rapidly. Follows is a list of resources to help providers stay abreast of the situation – and support their patients and families.

Local, state and federal resources, information

Provider guidance

The most current data

  • COVID-19 global cases dashboard by Johns Hopkins CSSE

Resources to share with patients and families

  • Information from CHOC Children’s experts, including a COVID-19 FAQ, tips for coping with anxiety, tips for parents of immunocompromised children, and hand-washing tips.

Printable materials for practices

Ocean Institute brings unique experience to CHOC mental health patients

Patients in the CHOC Children’s Cherese Mari Laulhere Mental Health Inpatient Center (MHIC) have a friend in Dana Point’s Ocean Institute, a non-profit aimed at educating SoCal youth.

The organization’s mission, “Using the ocean as our classroom, we inspire children to learn,” comes to life in the MHIC, where patients age 3-17 receive hands-on maritime education. It is a unique partnership – one that both patients and staff are passionate about.

After volunteering at CHOC for a long time with medical patients, Ocean Institute Distance Learning Programs Coordinator Danelle Hickman met with MHIC leadership to determine if bringing the Ocean Institute program onto the mental health unit would be feasible. It was a unique idea; few inpatient centers have any volunteers, let alone regular visits from a group of them. But despite the special considerations, everyone was determined to make it work.

After mental health-specific training, members of the Ocean Institute began their valued work in the MHIC in early 2019. Led by Hickman, the STEAM-inspired (science, technology, engineering, art and mathematics) program includes discussion, questions and answers, hands-on education, activities and art projects. The group also brings in sea animals for patients to see and touch.

Patients in the Cherese Mari Laulhere Mental Health Inpatient Center are able to see and touch live sea creatures during Ocean Institute lessons.

Hickman is passionate about offering patients an engaging experience.

“Our mission is to serve students from all walks of life. We are proud to provide programs for CHOC patients. This fills a community need for more than ‘feel-good’ programs; these powerful educational adventures aim to be life-changing.”

In an early December visit, their eighth of the year, Hickman and two Ocean Institute volunteers began the lesson by asking patients and staff to introduce themselves and discuss their favorite ocean animals. Answers around the table included sharks, whales, sea otters, sea turtles, seals and others. One patient chose jellyfish because of a memorable scene in the Disney-Pixar film “Finding Nemo.” Another patient chose dolphins, finding them “graceful but powerful when they need to be.”

The team then presented the patients with three varieties of live sea star and two preserved sea turtles. The group passed around the animals, noting some of them felt soft and others rough. The observation turned into a discussion about the difference between vertebrates and invertebrates; the patients worked together to figure out which category each animal falls into.

In one lesson, patients were introduced to a few different species of sea star and were able to compare and contrast their features.

Seeing the lesson unfold makes it clear why the Ocean Institute partnership is so valued in the MHIC.

“The thought of bringing ocean life onto an inpatient mental health unit was new for me,” says Director of the MHIC Dani Milliken. “Luckily, Danelle was so amazing, kind and flexible as we walked through all of our dynamics and special needs. And now, we couldn’t be happier with how the program has fit into our unit. Patients absolutely love having the Ocean Institute visit, and the buzz of excitement lasts long after each session. Even our most isolative patients enjoy interacting with the animals and teachers.”

For patients on the unit, the visits are about much more than learning about the ocean.

“Having community members come onto an inpatient mental health unit and be side by side with patients, learning and growing with them, is truly remarkable,” says Milliken. “It has been such an incredible journey so far, and we are so lucky to have the Ocean Institute program here at CHOC for such a vulnerable population.”

To Hickman and the Ocean Institute team, the joy of the partnership comes through seeing the kids as future ocean stewards who deserve to learn, play and discover during their time at CHOC.

The program’s STEAM-based curriculum incorporates creative expression as an important part of the learning process.

“Our programs allow patients to be heard and show them that others outside the hospital care about their thoughts and feelings. The program content affords them a way to visually and creatively express themselves, making choices that support the unique artwork that they create. Discussing the ocean and the animals that live there provides a positive common ground from which to build confidence in a safe environment.”

The partnership has become so cherished on both sides that the Ocean Institute, thanks to a generous donor gift, is bringing the program to CHOC’s MHIC twice per month in 2020.

Learn more about the Ocean Institute and the Cherese Mari Laulhere Mental Health Inpatient Center.