COVID-19 TRAINING FOR HEALTHCARE WORKERS 

Conducting a Virtual Visit   

Benjamin Lindquist, MD and David Hao, MD MS MPH 
 
LEARNING OBJECTIVES 
At the end of this lecture, the learner will be able to: 
1. Set Up a Virtual Visit 
2. Provide Care During COVID-19 Pandemic  
3. Understand Limitations of Telehealth 
 
LECTURE OVERVIEW 
I. Introduction 
II. Setting up Virtual Visit  
III. Completing Virtual History  
IV. Virtual Physical Exam Tips  
V. Tips for Managing COVID-19  
VI. Limitations of Telehealth 
 
I. INTRODUCTION 
1. Telehealth is the practice of caring for patients remotely using telecommunications 
2. Some of the benefits of telehealth during the COVID-19 pandemic: 
a. Improve access to care for rural and remote areas 
b. Preserve personal protective equipment 
c. Reduce risk of transmission of COVID-19 
d. Protect both patients and providers 
 
II. SETTING UP THE CALL 
1. Lighting  
a. Ensure adequate overhead light to illuminate providers face 
 b. Ensure more lighting facing the provider to avoid backlighting 
2. Camera Angle  
a. The camera angle should be directed at the provider’s face 
b. Look at the camera while communicating with the patient 
3. Audio  
a. Ensure good quality audio; use microphone as needed 
b. Speak slowly 
c. Pause for questions 
d. Avoid technical jargon 
e. Enunciate words 
 
III. HISTORY 
1. SAMPLE/OPQRST 
a. History is paramount for all patient encounters, especially during virtual visits  
2. Past medical history, past surgical history, allergies, medications, travel 
a. High risk patients should be identified early during evaluation  
3. Maintain good eye contact by looking directly at the camera 
a. Inform the patient that when the provider must look away from the camera to 
view patient records 
 
IV. VITAL SIGNS  
1. Have the patient help you calculate the vital signs 
a. Heart rate → count for 15 seconds and multiply by 4 
b. Respiratory Rate → observe breathing for 15 seconds and multiply by 4  
● Do not tell the patient you are watching breathing as this may 
cause them to breath abnormally  
c. Consider capillary refill as replacement of blood pressure 
● Instruct the patient to firmly hold down a finger in close view of 
their camera and then release, allowing the provider to count 
the seconds for the capillary refill 
 
 V. PHYSICAL EXAMINATION  
1. Pay careful attention to general appearance  
2. Identify respiratory distress and alteration of mental status  
3. Use bystanders to help with exam (e.g. shine light for oropharynx exam)  
 
VI. TIPS FOR COVID-19 
1. Identify High Risk Patients and refer 
appropriately 
a. Elderly  
b. High risk complaints include: 
● Chest pain 
● Altered mental status 
● Intractable vomiting 
c. Comorbid medical conditions include: 
● Hypertension  
● Diabetes 
● Cancer 
● Coronary heart disease 
● Chronic lung disease  
● Chronic kidney disease 
2. Complications include: 
a. Respiratory failure  
b. Acute Respiratory Distress Syndrome (ARDS)  
c. Thromboembolic events  
d. Inflammatory conditions  
e. Secondary bacterial and fungal infections  
 
VII. LIMITATIONS  
1. Not designed for high risk patients  
2. Internet connection and device quality  
 3. Sound and visual disturbances  
 
VIII. CONCLUDING THE VISIT 
1. Summarize the visit  
2. Provide return precautions 
3. Remind of quality practices to prevent spread of COVID-19  
a. Hand hygiene 
b. Mask wearing 
c. Social distancing 
 
SUMMARY 
I. Set up lighting, voice and audio 
II. Speak slowly and clearly 
III. Focus on the history  
IV. Observe general appearance  
V. Promote use of telehealth in COVID-19  
VI. Know limitations and refer to in-person evaluations as needed 
 
REFERENCES/SUGGESTED READING: 
1. Core Pendium. Accessed 08/17/20 ​https://www.emrap.org/corependium 
2. Gough F, Budhrani S, Cohn E, Dappen A, Leenknecht C, Lewis B, Mulligan DA, 
Randall D, Rheuban K, Roberts L, Shanahan TJ, Webster K, Krupinski EA, 
Bashshur R, Bernard J. ATA practice guidelines for live, on-demand primary 
and urgent care. Telemed J E Health. 2015 Mar;21(3):233-41. doi: 
10.1089/tmj.2015.0008. Epub 2015 Feb 6. PMID: 25658882. 
3. Miller EA. The technical and interpersonal aspects of telemedicine: effects on 
doctor-patient communication. J Telemed Telecare. 2003;9(1):1-7. doi: 
10.1258/135763303321159611. PMID: 12641885. 
 4. Gustin TS, Kott K, Rutledge C. Telehealth Etiquette Training: A Guideline for 
Preparing Interprofessional Teams for Successful Encounters. Nurse Educ. 
2020 Mar/Apr;45(2):88-92. doi: 10.1097/NNE.0000000000000680. PMID: 
31022072. 
5. Bond WF, Barker LT, Cooley KL, Svendsen JD, Tillis WP, Vincent AL, Vozenilek 
JA, Powell ES. A Simple Low-Cost Method to Integrate Telehealth 
Interprofessional Team Members During In Situ Simulation. Simul Healthc. 
2019 Apr;14(2):129-136. doi: 10.1097/SIH.0000000000000357. PMID: 30730469; 
PMCID: PMC6787919. 
6. Turer RW, Jones I, Rosenbloom ST, Slovis C, Ward MJ. Electronic personal 
protective equipment: A strategy to protect emergency department providers 
in the age of COVID-19. J Am Med Inform Assoc. 2020 Jun 1;27(6):967-971. doi: 
10.1093/jamia/ocaa048. PMID: 32240303; PMCID: PMC7184500. 
7. Al Hussona M, Maher M, Chan D, Micieli JA, Jain JD, Khosravani H, Izenberg A, 
Kassardjian CD, Mitchell SB. The Virtual Neurologic Exam: Instructional Videos 
and Guidance for the COVID-19 Era. Can J Neurol Sci. 2020 May 21:1-6. doi: 
10.1017/cjn.2020.96. Epub ahead of print. PMID: 32434626; PMCID: 
PMC7347716.