BEGIN:VCALENDAR VERSION:2.0 PRODID:Linklings LLC BEGIN:VTIMEZONE TZID:America/New_York X-LIC-LOCATION:America/New_York BEGIN:DAYLIGHT TZOFFSETFROM:-0500 TZOFFSETTO:-0400 TZNAME:EDT DTSTART:19700308T020000 RRULE:FREQ=YEARLY;BYMONTH=3;BYDAY=2SU END:DAYLIGHT BEGIN:STANDARD TZOFFSETFROM:-0400 TZOFFSETTO:-0500 TZNAME:EST DTSTART:19701101T020000 RRULE:FREQ=YEARLY;BYMONTH=11;BYDAY=1SU END:STANDARD END:VTIMEZONE BEGIN:VEVENT DTSTAMP:20220608T221758Z LOCATION: DTSTART;TZID=America/New_York:20220609T110000 DTEND;TZID=America/New_York:20220609T113000 UID:HFESHCS_2022 International Symposium on Human Factors and Ergonomics i n Health Care_sess176_INDLEC255@linklings.com SUMMARY:Virtual Family-Centered Rounds During the COVID-19 Pandemic – ; Technology Usability Analysis DESCRIPTION:Oral Presentations\n\nVirtual Family-Centered Rounds During th e COVID-19 Pandemic – Technology Usability Analysis\n\nAttef, Dulude , Trudel\n\nINTRODUCTION \nThe American Academy of Pediatrics and the Inst itute for Patient and Family-Centered Care recommend family-centered round s (FCR) is fundamental to inpatient pediatric care. FCRs consist of daily multidisciplinary care team meetings (e.g., physicians, nurses, patient, c aregiver(s), pharmacist, health care professionals and learners) that take place inside, or just outside, the patient’s room. Stakeholders dis cuss patient status, involve patients and caregivers in decision-making an d ensure everyone has a common understanding of the care plan. FCRs are st andard practice in many pediatric hospitals resulting in improved patient outcomes, patient and caregiver satisfaction, care team communication, and patient safety.\n\nIn-person FCRs have been used by the Children’s Hospital of Eastern Ontario (CHEO) since 2014. FCRs take place daily and i nvolve teams of 8-10 healthcare providers and learners meeting with patien ts and caregivers. With the onset of the COVID-19 pandemic, entering patie nt rooms was no longer advisable to maintain physical distance and preserv e personal protective equipment (PPE). In response, CHEO assembled a multi disciplinary team to develop a virtual process for FCRs. A pilot project ( April – July 2020) applying participatory design and rapid improveme nt cycles helped the team identify suitable (and readily available) techno logy to support Virtual Family-Centred Rounds (vFCRs). Rounds are now cond ucted virtually using a secure videoconferencing service (Zoom). Every mor ning, a rounding schedule is prepared by the unit clerk. Nurses deliver ta blets and earbuds to patients and caregivers when it is their turn for vFC R and disinfect the tools between users to support infection prevention an d control. Meanwhile, physicians, learners, and healthcare professionals ( e.g., pharmacists) join virtually from private offices or shared spaces (e .g., meeting rooms) where physical distancing can be maintained. During th is project, performance data and feedback from patients, caregivers and st aff suggested the process was effective, accepted by stakeholders, and pot entially useful post-pandemic. \n\nThe vFCR process continues to be used at CHEO more than 16 months later. In April 2021, a process evaluation was launched to evaluate vFCRs against the accepted standard of in-person FCR s to ensure high-quality care. Because vFCRs are dependent on technology ( devices, software, infrastructure), this evaluation also considered techno logy usability requirements and technical factors required to facilitate i mplementation and adoption.\n\nThe objectives of the vFCR technology evalu ation included identifying and documenting:\n1. technology usability requi rements through observation and evaluation of vFCR technology based on hum an factors principles. \n2. key characteristics of vFCR technology require d to support ease of use and adoption.\n\nPARTICIPANTS & METHODS \nThis st udy involved a review of FCR frameworks and readily available virtual heal thcare technologies. A human factors approach was used to identify user re quirements and specific characteristics that the system should include to support human performance. Naturalistic observation was conducted to colle ct data on real performance in context. The study received clearance from CHEO and Carleton University’s Research Ethics Boards.\n\nA research er observed vFCRs conducted by pediatric medicine teams over 5 weekdays. T hree days were on the unit and focused on clerk, patient, caregiver, and n urse interaction with vFCR technology. Two days were focused on observing technology interactions with physician teams joining vFCR virtually from m eeting rooms. Participants included: unit clerks; patients and their careg ivers; attending and learning physicians on 3 pediatric medicine teams; nu rses; and healthcare professionals contributing to patient care. \n\nThe r esearcher did not disrupt the process and approached staff afterwards to a sk questions as required. Observations focused on interactions with the te chnology used to support vFCR and were categorized using the AEIOU (Activi ties, Environment, Interactions, Object and Users) framework. Specifically , the researcher looked at what worked (i.e., requirements met) and what d id not work (i.e., un-met or new requirements) in the context of the 5 qua lity components of usability: learnability, efficiency, memorability, erro rs and satisfaction. \n\nRESULTS \nOver a 5-day period, a researcher obser ved 35 of 45 rounds with multidisciplinary care teams. There was a total o f 73 participants: 5 patients, 23 caregivers, 14 learners, 2 healthcare pr oviders, 5 attending staff physicians, and 24 nurses. According to existin g documentation, rounds should take approximately 10 minutes per patient, with a 2-minute window to collect and clean equipment, hand over the techn ology and transition to the next patient. Observation data revealed an ave rage rounding time of 8.4 minutes (min: 2 minutes; max: 21 minutes), and a n average of 3.7 minutes (min: 0 minutes; max: 12 minutes) to hand over te chnology to the next nurse/patient. Time delays were most often related to scheduling and nurse availability, not technology. \n\nA number of techno logy requirements were validated or identified through observation of succ essful interactions (what did work). Specifically, ease of use and learnab ility of vFCR technology were mostly supported by the consumer technologie s implemented to support vFCR (e.g., Zoom and iPads). Application settings including ’Always Display Participant Names’ and ‘Alway s Show Meeting Controls’ helped ensure the system was ready for  216;pickup and use’ following familiar conventions with minimal inst ructions. A consistent setup of vFCR tablet carts with all required equipm ent (e.g., headsets), cleaning supplies, and instructional tip sheets stuc k directly to the carts, supported learnability and memorability. Other as pects of the vFCR equipment design including mobility and a height adjusta ble work surface supported efficient delivery of devices to patients and c aregivers and nurse note taking. \n\nTechnology requirements were also val idated or identified through observation of issues or errors (what did not work). For example, the configuration of multiple devices joined to the s ame videoconference in proximity (either on the unit or in shared conferen ce rooms) was unintuitive and led to use errors, poor sound quality (when the prescribed technology setup was not followed) and confusion. Tip sheet s affixed directly to the rounding carts served as effective reminders but were insufficient in the absence of an initial verbal explanation of vFCR technology setup and use. This was observed repeatedly as new and/or infr equently scheduled staff cycled through the care teams (e.g., residents an d nursing students on rotation). \n\nObserving the impact of met and unmet technology usability requirements helped identify key characteristics req uired to support ease of use and adoption, including: secure and reliable software and wireless network infrastructure, hands on training, and exper t users within every team who can support new staff as they become familia r with less intuitive aspects of technology setup. \n\nDISCUSSION\nVFCRs depend on technology (devices, software, infrastructure). Findings on user interactions with vFCR technology suggest familiar consumer technology ca n support ease of use and learnability. However, when the implementation v aries from familiar configurations, error and confusion can arise. Charact eristics of the organization, including space constraints and limited avai lability of private offices, led to a more complicated and unfamiliar tech nical setup for physician learners joining the same videoconference from m ultiple devices in the same meeting room. This, in addition, to constantly changing patients, caregivers, nursing and physician learners and rotatin g shift schedules highlighted the importance of simple technology configur ations. Signage and tips sheets can support recognition vs. recall, but ha nds-on training is required to support vFCR participants when optimal lear nability and usability requirements are not met by technology alone. These findings suggest the impact of small usability issues should not be under estimated when implementing vFCR technology. \n\nThis case study focused o n observing one site which limits generalizability and highlights difficul ties in the evaluation of interventions to improve complex aspects of heal th care delivery. While naturalistic observation yielded clear results in terms of technology usability from the perspective of learnability, effici ency, memorability and errors, user satisfaction was not thoroughly examin ed. Work is underway to compare these findings with results of a patient and provider satisfaction survey, distributed to vFCR participants during the study. END:VEVENT END:VCALENDAR