Translational Projects (Open Access)

Graduation Date

Spring 2023

Degree Name

Doctorate in Health Informatics (DHI)

School Name

McWilliams School of Biomedical Informatics at UTHealth Houston

Advisory Committee

Robert Murphy, MD


Patient and family-centered care strategies see patients and families as valuable healthcare team members. Such strategies thus treat these groups as essential clinical partners in providing safe, high-quality care. Participation, collaboration, and shared decision-making are central to this framework. Historically, hospitals have relied on physical presence at the bedside as a prerequisite to engaging families in the shared decision-making process. Visitor restrictions of the COVID-19 pandemic removed the primary strategy for family participation: physical presence. Healthcare organizations rapidly deployed mobile devices to help minimize the exposure of healthcare providers and provide video visits for family members. This deployment was often rushed, with minimal workflow analysis, role definition, or standard operating procedures. These deficiencies led to low adoption rates, poor user satisfaction, and often unanticipated clinician distress when used at patients’ end of life. A better understanding of these virtual tools is necessary to ensure high-quality patient care.

The present quality improvement project aims to understand workflow; organizational barriers to adoption; and provider, family, and patient-related barriers to successfully using virtual communication in the acute care setting. The setting of this project was the intermediate care unit of a 140-bed community hospital that is part of a not-for-profit health system in the southwestern United States. Semi-structured interviews were performed to capture the lived experiences of family members and healthcare workers who used the virtual visit intervention during hospital visitor restrictions. The findings from these interviews, a literature review, and a workflow analysis identified several themes of the current tool's benefits, barriers, and enhancements. These themes were mapped to the sociotechnical model of healthcare information technology adoption to identify and suggest successful design criteria for a standardized virtual intervention. This intervention could be applied when external interactions are limited, like the pandemic or individual family circumstances. Overall, participants found that the intervention during the COVID-19 pandemic provided comfort and closure, facilitated family-shared decision-making, and reduced patient loneliness. Areas of opportunity include device availability, features, application usability, virtual communication techniques, and standardized workflow. Although hospital visitor restrictions due to the COVID-19 pandemic are no longer in place, the lessons learned, and the criteria identified can help standardize and improve family-centered communication strategies when family members cannot be physically present in the hospital.


family-centered care, virtual visiting, family communication, COVID-19



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