Most Madison House volunteering programs have been unable to operate as normal for nearly a year now. In-person volunteering continues to be suspended, however, three of the almost 40 Madison House Medical Services programs — Rounding with Heart, Pediatric Genetic Counseling and Spanish Interpretation — have found creative ways to overcome these limitations and continue to execute the Madison House mission of serving the needs of the Charlottesville community through virtual means.
Rounding with Heart was founded in 2015 and serves as a program that partners with the cardiology unit of the University Hospital to provide volunteers to help with scheduling rounds — a practice where a healthcare team discusses the status and treatment plan of each patient. The rounding program was done in person prior to the pandemic and is one of the few medical services programs feasible for a switch to a virtual setting through Webex — a video conferencing platform protected by the U.Va. Health firewall.
Volunteers are tasked with making sure that the whole healthcare team, a group of 10 to 15 professionals, are present at video conferences to round — a process in which various medical professionals come together to discuss patients’ condition and plans for ongoing care.
Madison House leadership and University Hospital Volunteer Services began coordinating the switch to virtual in September, and volunteers began serving in the first two weeks of November. Rounding with Heart has continued with 10 student volunteers as is typical for in-person sessions, however, volunteers are now split up by attending physician and service — Heart Failure and Acute Cardiology — rather than by location on the fourth floor of the hospital.
Graham Quinn, fourth-year College student and head program director for Madison House Medical Services, played a lead role in the transition of Rounding with Heart to a virtual format.
Although he has not had previous experience volunteering for the Rounding with Heart program specifically, last year he served as a coordinating program director and thus gained experience working directly with the University Hospital’s volunteer services office to operate programs efficiently. Quinn explains that the nature of the volunteer work made the online transition relatively smooth.
“Ultimately, [volunteers] were able to work with the University Hospital volunteer coordinators to make it work,” Quinn said. “We tag along helping with similar roles that we did before … We listen to rounding. The attendings change every week, and the residents change every couple weeks.”
Before beginning to volunteer independently, Rounding with Heart volunteers are required to undergo training which involves watching a 30-minute video that provides more information and instruction on how to make the schedule for rounds and how to page the nurses through the hospital’s software — which is accessible remotely through the student’s laptops. Then they must join in on the virtual shift of the head program director or the Rounding with Heart program director to conduct a trial run of making the schedule and listening in on rounds alongside an experienced volunteer.
“If after watching the video, making the practice schedule and observing a rounds shift the volunteers feel comfortable jumping in to volunteer on their own, then we'll schedule them in for a shift,” said Connie Jiang, a fourth-year College student and Rounding with Heart program director. “If they still feel like they need more practice, however, they can observe as many shifts as they want and make as many practice schedules as they want until they feel ready to volunteer by themselves.”
Rounding with Heart volunteers focus primarily on the timing of having the patients’ nurses join the video call. In order to time reminders for nurses, volunteers sit in on the rounds so they know the optimal time to page the nurses to join the call when they are moving from one patient to the next. This allows for nurses to attend the discussions specifically for the patients they are assigned so they can quickly return to their other responsibilities after rounding sessions.
“Everyone on the team meets virtually for rounding except for the nurses who are in person doing their jobs in the hospital,”Jiang said. “We have a huge need for nurses right now, and they are very busy. We just try to make sure that the nurses are logging on at the right time for a specific interval of time, so they do not waste any time they could be spending on other patients because their time is very valuable.”
Rounding with Heart volunteers require access to the electronic medical records of patients at the University Hospital, so that they can efficiently schedule rounds according to the nurses who are assigned to each patient. This presented a challenge when trying to shift the program to a virtual format. When volunteers operate on the hospital’s computers during in-person volunteering, the records are protected by the U.Va. Health System’s firewall, so in order for volunteers to operate from home on their personal laptops, they first had to get approval from many hospital departments including corporate compliance, risk management and medical center security to avoid any HIPAA violations.
“Remote volunteering like this is completely unprecedented — we would never have had students accessing the electronic medical records from their dorm rooms or apartments before,” University Hospital volunteer coordinator Maureen Oswald said. “But COVID-19 has forced us to get creative to continue serving the community where we can. It was a wonderful example of taking what an in person volunteer role is doing and looking outside the box — carefully for safety, confidentiality and HIPAA rules — to have volunteers safely support the hospital.”
Volunteers — who have to sign HIPAA compliance forms and complete training prior to volunteering at the hospital — face additional HIPAA concerns when it comes to having information overheard by others who have not complied to HIPAA guidelines. Many college students live in houses or apartments with multiple other students and some even share bedrooms, so creating a safe space to exchange private information can be difficult.
“You need to respect the patient's private information, so being in a setting in your room instead of in the hospital, apartments with roommates present challenges,” Quinn said. “It is important for the volunteers to be in a space where they can put in headphones and close the door to respect the patient's privacy.”
In addition to privacy concerns, the program’s transition to remote volunteering has made it difficult for volunteers to foster personal connections with the members of the healthcare team as well as with the patients themselves. Rather than being physically present and engaged in the rounding process, Rounding with Heart Volunteers now sit behind a computer with their video and sound off, unable to fully embrace the collaborative environment and make connections.
“I never did Rounding with Heart in-person, but I was talking to the previous program director and they said that they would get to know the residents, attendings and other healthcare professionals that they would round with every week,” Jiang said. “Now with virtual volunteering, I have to keep my video and my audio off because I obviously do not want to be a distraction, so it is hard to form those relationships with the people we work with when we aren't able to see each other's faces.”
Oswald expressed similar sentiments of isolation with the lack of in-person volunteers. She is able to work in-person from her office in the University Hospital. However, the dynamic within the hospital has changed drastically with volunteer and visitor limitations.
“I miss our volunteers,” Oswald said. “One of the things I love about my job are the many interpersonal connections that I have every day. My door is always open, and I get a lot of energy from those interactions with others. When there was a furlough there was this quiet that happened, and that was hard to adjust to.”
Although volunteers have lost the benefit of fostering relationships and learning how to interact with staff and patients, many of the important skills that Rounding with Heart offers have not been lost in the transition to virtual operations. Quinn describes the benefit of still being able to listen in on the rounding process — despite being unable to actively participate in the conversations — in learning how healthcare professionals talk and work effectively as a team with diverse expertise.
“The role itself is really efficient for being online,” Quinn said. “They all tend to go at different speeds, so you learn a lot of the jargon. A lot of the volunteers are premed students, and it is an invaluable experience being able to listen in on those conversations and the medical decision making that takes place.”
As a premed student who has recently been accepted to medical school, Jiang echoes the value that Rounding with Heart has had on her and her future career as a physician. This volunteering experience has allowed her to observe the different approaches that the healthcare team will take depending on a patient’s personal situation.
“One of the biggest things I learned while volunteering is how multidimensional patient care is and how there are so many sides to consider in the state of health of the patient and what treatments and medication they need,” Jiang said. “I know for some of the calls I have been on the doctors consider if the patient can afford their medication, and if they can't they will try to prescribe alternate medications. It showed me how comprehensive patient care should be, and I am glad that U.Va. takes it very seriously.”
Ultimately, the success of the Rounding with Heart program, among other virtual Madison House volunteering programs, under the constraints of the pandemic may change the future of volunteering, particularly within hospitals. When volunteering programs like this one can function efficiently and effectively without requiring an increased risk of virus transmission to other staff members and patients, the benefits may outweigh the costs.
“For a few of our roles, this transition to online volunteering may completely change the future of volunteering,” Oswald said. “We know that in-person is a wonderful thing, but we are now at a point where infection control and epidemiology will drive how we support our patients to keep them safe. We are still going to need boots on-Grounds, in-person volunteering, but how we have done things in the past are going to change because of the pandemic.”
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