Innovating in a crisis: a qualitative evaluation of a hospital and Google partnership to implement a COVID-19 inpatient video monitoring program.

OBJECTIVE: To describe adaptations necessary for effective use of direct-to-consumer (DTC) cameras in an inpatient setting, from the perspective of health care workers. METHODS: Our qualitative study included semi-structured interviews and focus groups with clinicians, information technology (IT) personnel, and health system leaders affiliated with the Mount Sinai Health System. All participants either worked in a coronavirus disease 2019 (COVID-19) unit with DTC cameras or participated in the camera implementation. Three researchers coded the transcripts independently and met weekly to discuss and resolve discrepancies. Abiding by inductive thematic analysis, coders revised the codebook until they reached saturation. All transcripts were coded in Dedoose using the final codebook. RESULTS: Frontline clinical staff, IT personnel, and health system leaders (N = 39) participated in individual interviews and focus groups in November 2020-April 2021. Our analysis identified 5 areas for effective DTC camera use: technology, patient monitoring, workflows, interpersonal relationships, and infrastructure. Participants described adaptations created to optimize camera use and opportunities for improvement necessary for sustained use. Non-COVID-19 patients tended to decline participation. DISCUSSION: Deploying DTC cameras on inpatient units required adaptations in many routine processes. Addressing consent, 2-way communication issues, patient privacy, and messaging about video monitoring could help facilitate a nimble rollout. Implementation and dissemination of inpatient video monitoring using DTC cameras requires input from patients and frontline staff. CONCLUSIONS: Given the resources and time it takes to implement a usable camera solution, other health systems might benefit from creating task forces to investigate their use before the next crisis.

Project TOPS: Team-Based Oversight of Patient Satisfaction Through Real-Time Interdisciplinary Feedback.

BACKGROUND: Despite the financial incentives to improve patient experience, measured through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, few interventions have led to sustained improvement. METHODS: A real-time survey (RTS) designed to capture multiple domains was conducted on medical inpatients in a tertiary care center from July 2017 to June 2018. Answers were reviewed by a multidisciplinary team, and interventions to improve experience were completed. RESULTS: A total of 235 RTSs resulted in 94 (40.0%) interventions. HCAHPS were compared 12 months pre-and postintervention, with an increase in the percentage of "always" for the responsiveness domain, 38.9% vs. 59.7%, p = 0.005. Several other domains showed an increase that did not reach statistical significance. CONCLUSION: Conducting RTSs may allow for a better understanding of patient experience and active service recovery.