Virtual hospital ward rounds have been a feature of some medical specialities for around two decades. But as the novel coronavirus spread rapidly in early 2020, the importance of restricting the exposure of the health workforce to infectious patients pushed the needle for this form of telemedicine.

Traditional in-person hospital ward rounds involve a range of healthcare staff including clinicians, discharge co-ordinators and medical students, who travel from bed to bed making observations, or clustering around computer screens to assess test results, all the time increasing the risk of covid-19 transmission. To reduce this risk, a number of larger hospital systems adapted quickly to introduce virtual rounds. That this process of adoption happened with relative ease could encourage further scaling up of the service after the pandemic is finally over. 

Virtual rounding, as it is often known, is an established way of parachuting additional, and sometimes geographically distant, expertise into a patient’s hospital room since digital platforms began to make remote consultations possible.

Before the pandemic, in some primary care systems, including in the UK, virtual rounding allowed general practitioners, social workers and other health providers to consult on and monitor frail elderly patients in the community, or to allow specialists to give remote expert opinion where a fast diagnosis might affect outcomes, such as in cases of suspected stroke.

In 2019 researchers in Canada launched a study of a pilot project, the Telemedicine Rounding and Consultation (TRAC) model, to examine efforts to relieve the problem of over-occupancy at two paediatric hospitals in Alberta by increasing the number of patients cared for in regional paediatric beds via telemedicine. The researchers, who aimed to identify potential barriers and enablers to the TRAC approach, suggested that it could be used by others to develop similar telemedicine-based interventions in Canada and other parts of the world.

As the covid-19 pandemic has spread across countries, the technology has been used to serve a number of functions simultaneously: virtual rounds have become a way of keeping patients and medical staff safe, making care more efficient and preserving scarce personal protective equipment (PPE). Whether or not hospitals will continue to take up virtual rounds in the future is likely to depend in part on how long the pandemic continues, and the extent to which telemedicine is adopted more widely. 

A strategic take up of virtual rounding could make it easier for healthcare systems to provide care more widely, across greater distances and in a more cost-effective way. According to the OECD, this could help to address the growing gaps between the demand for and availability of health workers needed to care for patients. In addition, proponents say, wider use could allow sharing of expertise between countries and between tertiary and regional medical centres, as well as providing more patient-focused care, especially in areas such as paediatrics. In this case study, we look at how two hospitals are using virtual rounding.

Executive summary 

• The coronavirus pandemic has enabled the take up of many aspects of telemedicine that had only a niche appeal before 2020, and virtual hospital ward rounding is likely to remain of interest to many physicians and patients after the pandemic is over. Yet, virtual rounding cannot be seen as a one-size-fits-all service. Hospitals that understand the needs of both patients and healthcare providers are most likely to put virtual rounding to the most efficient use.
• Virtual rounds can be used in both in-patient settings and to monitor care in the community, including in nursing homes. Physicians in the UK have used the technology to supervise the care of frail elderly patients who have been discharged from hospital.
• Benefits of virtual rounding during the coronavirus pandemic have included preserving scarce personal protective equipment (PPE) and limiting the number of healthcare staff who are required to self-isolate due to exposure to infectious patients. It also allows a broader range of specialists and support staff to consult on patient care remotely. The technology also allows families to dial in to rounds remotely, helping them to improve their understanding of a relative’s condition and see them in cases where face-to-face visits are not possible.
• Virtual rounds can present challenges, though. They deprive most participants, including medical and nursing students, of the opportunity to do a physical examination on the patient although they can also act as teaching tool. In addition, the technology is not suitable for all patients, and the investment costs can be high for smaller hospitals.
• Future opportunities for the technology include allowing larger tertiary medical centres to provide expertise and supervise care remotely at community hospitals. Virtual ward rounds could also help to make hospital care more cost-effective by sharing expertise across hospital facilities as needed.