Smart glasses allow specialists to do virtual ward rounds

Through smart glasses worn by residents, neurosurgery specialists can safely and feasibly conduct rounds in critical care wards, according to a recent Malaysia study.

“The coronavirus disease 2019 (COVID-19) pandemic poses major risks to healthcare workers in neurocritical care. Recommendations are in place to limit medical personnel attending to the neurosurgical patient as a protective measure and to conserve personal protective equipment,” the researchers said. The present study looked at whether smart glasses could help overcome this challenge in the neurosurgery setting.

Two consecutive ward rounds were conducted by a random pair of neurosurgery specialist and resident. The virtual round was conducted remotely by a specialist who received audiovisual information from an onsite resident wearing smart glasses. Subsequently, the pair then personally visited the same patient. The resulting management plans were compared between the two approaches.

After 10 pairs of ward rounds, with 103 patients visited, a total of 231 management decisions and plans were delivered. Of these, only 19 ended up being changed after the physical rounds. This resulted in an “excellent” interrater reliability, with an intraclass correlation coefficient of 0.936. [World Neurosurg 2020;doi:10.1016/j.wneu.2020.09.076]

Looking at each individual paired round, the researchers found that all but one had good to excellent internal consistency, with Cronbach alpha values exceeding 0.8. Notably, two pairs of rounds required no change in the management plan (Cronbach alpha, 1.000). In another three pairs, only one change was requested.

The remaining pair of ward rounds that failed to achieve good to excellent inter-rater reliability nevertheless had acceptable internal consistency, with a Cronbach alpha value of 0.75.

Moreover, 12 of the 19 changes in treatment decisions were due to the development of new information in the time interval between the virtual and in-person visits. The remaining seven cases were due to inadequate information during the virtual rounds. There were no inaccuracies in the information relayed through the smart glasses.

Though highly useful, residents may have trouble using the smart glasses device. During the first paired ward rounds, the resident experienced nausea and dizziness, and as a result, only five patients were visited. Prior to the following rounds, the researchers conducted a training session for both residents and specialists, where optimal device use was taught.

This led to overall high user experience scores. Almost all domains (clinical accuracy, reliability, overall efficacy, user friendliness, and user satisfaction) were rated as excellent. The final criteria, technical quality, was rated as good.

“By using the smart glasses, specialists monitoring the ward rounds were able to direct residents and junior staff members through the routine daily review of patients requiring critical care. This included physical examination, review of physiologic parameters, review of medications, blood results, radiologic imaging, and wound management,” the researchers said.

“Therefore, the specialist was able to holistically and continuously ‘see’ the exact first-hand clinical information in real time and in a ‘bedside’ manner to advise and guide the resident confidently and accurately,” they added. “Nevertheless, as with any health care technology, attention must be paid to certain technical details, training requirements, and clinical nuances to achieve optimal outcomes.”