Virtual Procedural Supervision during the COVID-19 Pandemic: A Novel Pilot for Supervising Invasive Bedside Procedures in the ICU

Koubek, Richard; Brady, Anna; Gopalratnam, Kavitha; Oeckler, Richard; Kennedy, Cassie C.; Kelm, Diana

The ability to perform invasive bedside procedures (IBPs) safely and efficiently is a core skillset within critical care medicine. Fellowship training provides a pivotal time for learners to attain baseline proficiency in such procedures to decrease patient complications. The COVID-19 pandemic has posed distinct challenges to the traditional model of teaching and supervising IBPs in the intensive care unit (ICU), including stewardship of personal protective equipment (PPE) and limiting healthcare worker exposure to persons with COVID-19. To address these challenges, we piloted a novel method of IBP supervision and teaching utilizing a virtual monitoring system. In this virtual procedural supervision model, the supervising teacher is located outside of the patient room, limiting PPE utilization and healthcare worker exposure. An audio-visual monitoring system allowed communication between teacher and learner, and supervisor visualization of the procedural encounter. Virtual supervision was utilized for central line placement and bronchoscopy in the medical ICU with no complications or instances of the supervisor needing to enter the patient room. Success was felt to depend on camera positioning, pre-procedure planning, and to be best for advanced learners who would not require tactile feedback. Upper level learners appreciated autonomy granted by this process. Virtual IBP supervision is felt to be a useful tool in specific situations. As with any tool, there are notable strengths and limitations. Success is felt to be optimized when attention is paid to procedural teaching best practices, learner selection, and technological logistics.