"You have to hold their hand": experiences of providers integrating virtual care and communication methods while caring for ICU patients during the COVID-19 pandemic.

Background: The rapid expansion of synchronous telephone and video virtual care options allowed the Veterans Health Administration (VHA) to adapt to the coronavirus disease 2019 (COVID-19) pandemic and provided a unique opportunity to assess the potential for integration and utility of virtual care in VHA systems. The objective of this study was to highlight the perspectives of VHA providers caring for intensive care unit (ICU) patients during the COVID-19 pandemic and their views on the use of virtual care and communication for palliative and end-of-life patients.

Methods: Forty-eight semi-structured qualitative interviews were conducted with providers between April 2021 and March 2022 and were analyzed using steps informed by thematic content analysis. Participants were eligible if they delivered ICU care to surgical patients at VHA hospitals. Participants were recruited from 14 VHA facilities across the United States. Participants were asked questions about their experiences as providers working with ICU patients, including about the impacts of the COVID-19 pandemic and ways in which virtual care was adapted to deal with emerging challenges.

Results: When asked about their experiences with ICU patient care during the COVID-19 pandemic, participant experiences showed: (I) disruption of staff roles and responsibilities, (II) reduced opportunities for communication and rapport building with family members, and (III) increased patient isolation. In each case, virtual options were adapted to overcome these emerging barriers, but limitations for the utility of those options for palliative and end-of-life care patients remain.

Conclusions: Virtual options were an important adaptation for providers during the COVID-19 pandemic, but their use can be limited in palliative and end-of-life care settings. However, when visitation is limited, virtual options can support communication between providers, family members, and caregivers.