Remote Rounds And Hospital Medicine Lessons From 2017

Hospital Medicine 2017 brought hospitalists and allied healthcare professionals together at Mandalay Bay Resort and Casino in Las Vegas from 1–4 May 2017. The Society of Hospital Medicine event focused on research, practical care, innovation, professional development and continuing medical education. Within that setting, telemedicine offered a useful way to reconsider where clinical expertise had to be located.

The Hospital Medicine and Telemedicine discussions of that period centred on remote rounding, virtual consultation and technology-supported teamwork. These approaches were intended to extend the reach of hospitalists, connect smaller facilities with specialists and improve decision-making when the senior clinician was not physically beside the patient.

For Australian hospitals, the subject remains relevant because care is delivered across densely populated capitals, outer suburbs and very remote communities. A model developed for Las Vegas could not simply be copied into Sydney, Melbourne, Brisbane or regional Western Australia. It would need to account for Medicare arrangements, privacy law, workforce patterns, internet access and the practical habits of local clinical teams.

Why Remote Rounding Attracted Attention

Traditional ward rounds depend on a doctor, nurse and other professionals being in the same place at the same time. A remote rounding model changes that arrangement by using a secure video connection, a mobile cart, a fixed bedside screen or a workstation linked to the electronic medical record. The remote hospitalist can review observations, speak with the patient and coordinate decisions with staff at the bedside.

This format was especially attractive to hospitals with gaps in overnight cover, limited access to subspecialists or a fluctuating patient census. It could also support escalation when a patient deteriorated and the local team needed a second opinion. The technology did not remove the need for nurses and doctors on site; it made their collaboration with an off-site clinician more immediate.

The 2017 conversation was also shaped by improved cameras, larger displays, electronic prescribing and more reliable broadband. Even so, the important question was clinical rather than technical: which decisions could safely be made remotely, and which required a physical examination or procedure?

Models Discussed In The 2017 Era

A hub-and-spoke arrangement was one of the clearest models. A central hospitalist team served several smaller hospitals, conducting scheduled virtual rounds and responding to urgent calls. The spoke site supplied bedside nursing, local examination findings and hands-on treatment, while the hub contributed medical oversight and access to broader expertise.

A second model paired an on-site clinician with a remote specialist. In this arrangement, a rural doctor or nurse practitioner assessed the patient directly while a hospitalist, intensivist or infectious diseases physician joined by video. This approach reduced professional isolation and allowed the local team to retain responsibility for immediate care.

Virtual evening coverage was another practical option. A remote hospitalist could review admissions, help prioritise deteriorating patients and advise on transfers. Such services worked best when there were clear handover rules, defined response times and a reliable method for viewing pathology, imaging and medication records. A video call alone was not a complete clinical service.

The wider educational material from the meeting also connected telemedicine with everyday quality improvement. Hospital teams interested in applying its lessons could pair virtual review with clinical updates, using evidence-based changes to standardise assessment rather than treating video as a substitute for sound process design.

Designing A Safe Virtual Ward Round

Preparation determined whether remote rounds were useful. Before the call, the bedside team needed to confirm the patient’s identity, gather vital signs, check current medicines and have relevant results available. The remote clinician needed a concise handover that covered the reason for admission, changes since the previous review, active risks and the proposed plan.

Communication with patients required equal care. A clinician appearing on a screen should introduce themselves, explain where they are located and describe who is physically present. Patients should know how to ask for clarification and how their information is being protected. Good camera placement matters: the patient should be visible, the clinician should maintain eye contact as far as possible and conversations should not occur within hearing distance of unrelated people.

Remote assessment has limits. Abdominal tenderness, neurological signs, mobility and subtle changes in appearance may be difficult to judge through a screen. The protocol therefore needs triggers for an in-person review, transfer to a higher-acuity service or immediate attendance by the local doctor. Safety depends on recognising those limits early.

Documentation should state who participated, what information was reviewed, what could not be assessed remotely and who accepted responsibility for the next step. This reduces ambiguity when several organisations share care. It also supports audit, credentialing and review of adverse events.

What Australia Would Need To Adapt

Australian geography makes a distributed model appealing. A tertiary service in Melbourne or Sydney may support a smaller hospital in northern Queensland, the Pilbara or the Northern Territory, where recruitment and specialist access can be difficult. Time-zone differences, long travel distances and weather-related disruptions mean that remote advice can sometimes prevent an unnecessary transfer, though it must never delay one when the patient needs higher-level care.

Local systems would also need to fit telehealth into Medicare and hospital funding arrangements. In 2017, Medicare Benefits Schedule telehealth items were available in defined circumstances, with eligibility and billing requirements that did not automatically match every hospital-to-hospital service. Public hospitals, private facilities and Aboriginal Community Controlled Health Services could therefore face different operational pathways.

Privacy and consent would require attention to the Privacy Act 1988, relevant state or territory health-record rules and organisational policies. A service in New South Wales might use a different platform or approval process from one in Victoria or Western Australia. Secure authentication, access controls, data retention and a documented downtime procedure should be established before clinical use.

Infrastructure is equally important. The National Broadband Network was expanding, but connectivity remained uneven, especially outside major cities. A service should have a fallback telephone process, local examination capability and a plan for dropped calls. Australian clinical teams also work within strong expectations around family involvement, interpreter access and culturally safe care, all of which must be preserved during a virtual encounter.

Measuring Value Beyond The Screen

A telemedicine programme should be assessed against patient and service outcomes rather than the number of completed video calls. Useful measures include time to senior review, unplanned transfers, length of stay, medication errors, rapid-response activation, readmissions and patient experience. For rural hospitals, avoided travel and improved access to specialist opinion may be important outcomes, provided clinical safety is maintained.

Workforce effects deserve close measurement. Remote rounds can reduce professional isolation and provide learning opportunities for local staff. They can also create extra work if bedside nurses must repeatedly reposition equipment, repeat information or manage two incompatible documentation systems. A successful service allocates time for virtual care and recognises the bedside team as a clinical partner.

Sepsis provides a good test case because early recognition and coordinated treatment depend on reliable communication. A remote hospitalist may help interpret warning signs, review antibiotics and support escalation, while the local team obtains cultures, starts treatment and monitors the patient. Practical guidance on sepsis bundle guidance can therefore complement, rather than replace, the virtual consultation.

Governance should include regular case review, simulation and feedback from patients, nurses, doctors and technical staff. Early pilots are often strongest when limited to a defined ward or a particular clinical problem. Expansion should follow evidence that the model is dependable during nights, weekends, high demand and equipment failure.

Comparing Remote Rounding Approaches

The comparison shows that no single format answers every workforce or access problem. A scheduled hub may suit a regional ward, while urgent specialist advice may be better delivered through a clinician-to-clinician consultation. The safest programmes combine several methods and state clearly when remote care ends and physical attendance begins.

The Lasting Lesson For Hospital Teams

The 2017 conference offered a useful historical view of telemedicine before virtual care became routine across many health systems. Its most durable lesson was that technology should follow a defined clinical purpose. A video cart, secure platform or electronic record creates value only when it improves assessment, communication, continuity or access.

For Australian hospitals, implementation should begin with the patient journey and the local workforce. Teams should identify the situations in which remote expertise can prevent delay, establish governance and privacy controls, train staff in virtual communication, and retain dependable bedside capability. Rural and metropolitan services may use different designs, yet both require clear accountability and respectful partnership with patients.

Remote rounding works when it strengthens the people already providing care. The point to remember is simple: telemedicine is safest and most effective when the screen connects clinical teams without obscuring who is responsible for the patient at the bedside.