SETTING UP THE VISIT

  • Make sure:

    • You are in a private setting
    • The background is neutral and professional
    • You wear the clothes you would normally wear for work

  • Technology considerations

    • The best lighting is in front of you and the patient, if possible
    • If feasible, make sure the camera and the patient’s face are lined up on the monitor – this will help with eye contact
    • For video visits, use a headset where possible – the sound quality for you and the patient is better that way.
    • Mute when not speaking and try to minimize background noise such as rustling of papers
    • Be mindful of audio delay, try to pause between sentences
    • Remember to protect your own confidentiality by blocking your personal phone number (if using a personal phone)

  • Review the chart (including Connecting Ontario) and consultation request as you would normally do prior to seeing a patient

  • Consider whether you need an interpreter to address language barriers, or caregiver to provide collateral information

    • Patients may occasionally ask to share a Zoom/OTN link or phone conference with a family member located elsewhere
    • If you are at home for the encounter
    • Make sure you have a reliable internet or phone connection
    • Discuss with your supervisor how to manage personal health information during and after the virtual assessment

AT THE BEGINNING OF EACH PATIENT ENCOUNTER

  • Confirm patient’s identity in at least two ways
    • If a video visit, you can ask them to show you photo ID
    • If a telephone visit, ask for date of birth and address
  • ·Confirm how to reconnect if connection lost
  • Lock the door or place a sign on the door to avoid interruptions
    • Clarify with your supervisor if you or a clinic administrator is responsible for obtaining this consent
Things to discuss with patients when obtaining consent for virtual care
·      Risk of unauthorized disclosure or interception of personal health information
·      Limitations in physical examination
·      What to do if urgent care is needed

INCLUDE A PARAGRAPH IN YOUR DICTATION SUCH AS:

“This patient visit was conducted by telephone/video visit instead of in-person due to the covid-19 pandemic.

Informed verbal consent was obtained from this patient to communicate and provide care using virtual and other telecommunication tools. This patient has been explained the risks related to unauthorized disclosure or interception of personal health information. We have discussed that care provided through video or audio communication cannot replace the need for a physical examination and the patient understands the need to seek urgent care in an emergency department as necessary”

REVIEWING THE CASE WITH YOUR SUPERVISOR

  • Your attending physician should make their preferences clear regarding how they intend to review cases seen virtually.  Please check in with them prior to seeing your first patient

For VIDEO visits:

  • Your attending may set up breakout rooms that allow you to go from patient encounter to reviewing space and back again
  • ·Your attending may be in the patient encounter with you (with video off and muted), which will allow them to directly observe the encounter
  • You may physically walk to another room to review with attending in person or by phone

For PHONE visits:

  • You may need to call your patient back after speaking with your attending to confirm the plan (give your patient an estimate for when you will call back)
  • You may need to place the patient on hold while reviewing
  • You may phone the attending and then participate in a three-way call with the patient
  • Your attending may come into the room with you and put the patient on speakerphone
What if your patient does not answer the phone/misses the virtual visit?
·       Try calling back another time later in the clinic.
·       Document attempts made to reach them.
·       If you are still unsuccessful in reaching them, please ask your attending physician for next steps

AT THE END OF EACH PATIENT ENCOUNTER (AFTER YOU REVIEW)

  • Ensure the patient understands the plan: “What questions do you have?”
  • Fill out all requisitions/forms and send to appropriate recipient(s)
    • Consider verifying the patient’s current address, or document their consent to communicate via e-mail
  • Ensure correct pharmacy information on file and call in prescriptions to pharmacies (or print them and mail to patient).
  •  Ensure follow-up is arranged, as necessary
  • This includes follow-up visits to address any limitations that have occurred with your virtual visit (for example, physical examination)
  • Complete your notes, as you would for any patient encounter
  • Get feedback from your staff
  • Guidance for future visits: what can your patient do to make their next virtual visit more effective
    • E.g. Weigh self beforehand? Measure their blood pressure in advance (if able)? Have medications beside them? Have a family member present to assist with physical exam and/or for collateral?

 

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