Special Issue
MHGC Proceeding 2021
Mental Health: Global Challenges Journal
https://mhgcj.org ISSN 2612-2138
Virtual Round care model
in a Covid-19 Geriatric sub intensive unit
Francesca Romana Greco, Grazia D’Onofrio, Filomena Ciccone, Francesco Giuliani, Sergio
Russo, Silvia Villani, Daniele Sancarlo, Antonio Greco
Geriatric complex Unit/Covid19 - IRCCS Casa Sollievo della Sofferenza Hospital
San Giovanni Rotondo, Italy
Introduction. Telepresence provides clinicians the ability to monitor patients as well to
communicate with all the members of the healthcare staff. Covid-19 Units cope with high
complexity in providing care and an integration amount the care team and the patients’
relatives should be carried out to obtained successful outcomes and preventing complication.
Virtual rounding (VR) has been successfully applied to cope with this task in the last 2000 years in
medical units. Covid-19 patients due to safety rules may be prone to isolation and lack of
communication with their family.
Purpose. The aim of our study was to evaluate the effect of structured virtual round protocol in a
geriatric Covid-19 unit on anxiety and depression for the patients and their relatives.
Methodology. All the patients admitted to the geriatric Covid-19 unit from 1 February 2021 to
30 April were studied. Inclusion criteria to the study were the followings: no severe cognitive
impairment (MMSE =>24) or neuro sensorial deficits; informed consent to participate to the
study. Forty-nine 49 (75% of patients) met the inclusion criteria. All the subject who were found to
be eligible to the study underwent a VR standard protocol of care. VR was consisted with: 1) a
video call with a tablet device conducted by a psychologist that established a cooperative
communication between the health care staff (nurses and MD, their relatives) at the bed sides;
2) a video call with the patient’s relatives in which it was clearly explained the standard care and
the role of each healthcare member was also included. Anxiety and depression levels were
assessed for the patients at baseline after the end of the protocol by the Hospital Anxiety and
Depression Scale (HADS). Patients’ relatives were investigated for depression at baseline and
after the end of the protocol by the Beck Depression Inventory- Primary Care (BDI-PC). The Beck
Depression Inventory for primary care has seven items with each item rated on a 4-point scale
(03). It is scored by summing ratings for each item (range 021). Items are symptoms of
sadness, pessimism, past failure, loss of pleasure, self-dislike, self-criticalness, and suicidal
thoughts and wishes. The Hospital Anxiety and Depression Scale (HADS) is a self- assessment scale
found to be a reliable instrument for detecting states of depression and anxiety. The anxiety and
depressive sub-scales are also valid measures of severity of the emotional disorder. The
questionnaire comprises seven questions for anxiety and seven questions for depression, and
takes 25min to complete. For both scales, scores less than 7 indicate non- cases, 8-10 mild,
11-14 moderate, 15-21 severe. JMP software by SAS (v.16) was used for the statistical analysis.
Results. The present study included forty-nine 49 patients (67% male), mean age of 69.9 ±14.7
years with one relative for each patient. The average mean of the hospitalization for each
patients was 17.6 ± 5.7 days The mean VR duration time was 60±5.5 minutes. VR showed a
significant decrease in both Anxiety and depression for patients: (HADS Depression baseline 10.6
±3.1 vs 6.9 ±2.7 end p<0.01) (HADS Anxiety baseline 10.2 ±3.4 vs 6.8 ±3.0 end p<0.01). VR
has also reduced depression in the relatives of patients (BDI-PC 3.6 ±2.4 vs 1.9 ±1.9 p<0.01).
Discussion. VR has reduced anxiety and depression in patients hospitalized in a sub-intensive
Special Issue
MHGC Proceeding 2021
Mental Health: Global Challenges Journal
https://mhgcj.org ISSN 2612-2138
COVID 19 unit and it also has been found to be effective in decreasing depression in the
relatives of these patients
Limitation. However, the study has some possible limitations considering its small size and that it
was mono centric
Conclusions. Our data confirm the efficacy of VR in the sub-intensive care setting. This evidence
supports the key role of a multidisciplinary team, focusing on the importance of social and
psychological support during the hospital stay.
More studies will be consequently necessary to better validate the importance of VR as a
standard care tool in intensive/sub- intensive care units for the elderly patients
Virtual Rounding, Telehealth, Psychology, Mental health, Covid-19.
Submitted for publication:
17 May 2021
Received: 17 May 2021
Accepted for publication:
26 July 2021
This research was supported by the
Geriatric Complex unit (Covid-19) I.R.C.C.S Casa
Sollievo della Sofferenza Hospital. We thank our
colleagues who greatly assisted the research.
Conflict of interest
Authors declare no conflict of interest
Sucher, J. F. et al. (2011) Robotic telepresence: A
helpful adjunct that is viewed favorably by
critically ill surgical patients. Am. J. Surg. 202,
Vranas, K. C., Slatore, C. G. & Kerlin, M. P. (2018)
Telemedicine coverage of intensive care
units: A narrative review. Ann. Am. Thorac.
Soc. 15, 12561264
Brooks, S. K. et al. (2020) The psychological
impact of quarantine and how to reduce it:
rapid review of the evidence. Lancet 395,
912 920
AS Zigmond. (1983) The hospital anxiety and
depression scale. Acta Psychiatr Scand 67,
Beck, A. (1997) Screening for major depression
disorders in medical inpatients with the Beck
depression inventory for primary care. Behav.
Res. Ther. 35, 78591