Aside from taking part in ISARIC, GenOMICC and RECOVERY, our research work during COVID has included digital innovation to help patients, their families and staff during the pandemic. 

Social distancing measures introduced in response to the COVID-19 pandemic resulted in an almost complete cessation of family bedside interaction, with negative effects on patients, families and staff. Here we report on measures introduced in response to this situation at the critical care unit in one hospital involving the use of videoconferencing technology. The solutions used also had the potential to be extended to clinical use, for example when seeking advice for colleagues, and to the provision of training.

Problem

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) led to a lockdown in the UK on the 23 March 2020 in an attempt to reduce transmission rates. Subsequent social distancing measures introduced by the UK Government also resulted in an almost complete cessation of friends and family visiting patients in NHS hospitals. Family bedside interaction is integral to the care we offer in the intensive care unit (ICU), and our team recognised that its loss would not only be heartbreaking for families, but also incur morale injury to staff. This is a short report of our iterative response to this situation, at the critical care unit of Worthing Hospital on the south coast of England.

Potential solutions

The structural adaptation of Worthing ICU was to temporarily expand from a single 12-bed unit into three units, caring for up to 40 patients. Twice-daily ward rounds were typically covered by separate teams and both of these were followed by a doctor-led ‘relative telephone round’. The named next of kin contact would receive a comprehensive update on the previous 24 hour’s events, with opportunities to ask questions, and was then advised to disseminate information as they felt appropriate. This daily communication also took the burden off the nursing staff, who found it difficult to communicate while wearing personal protective equipment (PPE).

We conducted a purposive and multidisciplinary staff survey – targeting 45 members of staff including physiotherapists, nurses (across experiences), healthcare assistants and doctors (including trainees and consultants) – to identify whether communication between staff and relatives was a problem, and if there were potential solutions to pursue.

From the 28 responses (62% response rate) we distinguished two key themes among the solutions proposed: video calling and/or reserving a room for face-to-face meetings. Given video calling would allow compliance with the UK Government social distancing guidelines, we decided to pursue this option further. Guidelines from the Information Commissioner’s Office confirmed that video calling would not be a breach of data protection laws¹ and NHSX released guidance encouraging the use of mobile devices to prevent total isolation from loved ones.² Following collaboration with our Information Management and Technology team, four iPads were purchased (one to each of the three critical care areas and one in the doctor’s office), and restricted to Facetime software (Apple, Inc). Relatives were offered the opportunity to have a ‘virtual visit’ through a video call. If accepted, a preparatory explanation of what would be seen was given to the relative in an attempt to minimise any distress. Afterwards staff on the unit in PPE would call with the iPad at the bedside.