vCreate: A new communication tool during Covid-19 in Adult Critical Care

vCreate: A new communication tool during Covid-19 in Adult Critical Care. NHS Lothian Case Study

Authors: Tait JE, Thomson A, McCulloch C, Rodgers S, Tocher J, MacKinnon L, Wheelhouse M, Nunn K, Graham A, Jordan H, Abu-Arafeh A, Wilson E.

Background

The Covid-19 pandemic has brought unprecedented challenges to the critical care environment and the patients and families it treats. Significantly restricted hospital visiting has impacted hugely upon our service. The absence of face-to-face communication with families has heightened anxiety and distress for both the critical care team and families. Communication between critical care team and families of patients in the intensive care unit (ICU) is vital to allow comprehension of a patient’s condition and fully explain our decision-making (1).

We have found that patient families struggle more to understand disease severity without physical presence with their loved ones. End of Life discussions have been extremely difficult without forms of non-verbal support. The implementation of vCreate and video-conference calls has created a virtual presence of patient families within adult critical care during Covid-19.

vCreate

In the very early stages of the pandemic the Scottish Government issued guidance recommending the use of video communication while family visiting was restricted. NHS Scotland chose Near Me as their preferred live video consultation tool as this was already used in general practice and remote clinics. The Scottish Government also funded an additional online application, vCreate, that could provide asynchronous communication for use in adult and paediatric ICU. vCreate had been developed in Glasgow Royal Hospital for Sick Children in 2017 by Dr Neil Patel, NICU Consultant, and had been rolled out to other paediatric units but the use of vCreate – or any virtual communication tool – was novel within adult critical care.

vCreate is a secure online application used to send photos and video clips of patients and staff to family members. Media content can be captured and approved prior to sending to families. This benefit over instantaneous video calls means we can capture events when they happen, watch the content and ensure it is appropriate to send, prepare families for the content and store the clips and photos so they can be viewed by either the family or patient at a later date. These visual updates are intended to complement regular phone and live video medical and nursing updates.

Implementation

Dr Elizabeth Wilson, Consultant in Intensive Care Medicine at the Royal Infirmary of Edinburgh led the implementation of vCreate in NHS Lothian. As this was an application designed for paediatric and neonatal ICU there was no standardised training, guidance or information governance in place for its use within adult ICU. This was rapidly developed and approved by both NHS Scotland and NHS Lothian. A Scottish wide network was created to help support units with using this new technology and share ideas on its best use. This initial phase of implementing and training staff relied on critical care staff who were non-clinical due to the pandemic or staff redeployed from other areas. We had exceptional support from the IT department in NHS Lothian, the vCreate team and the Scottish Network during this time which enabled it to become such a success.

The rapid implementation and adoption of an entirely new method of communication during the Covid-19 pandemic was not without difficultly. The particular challenges we faced included:

Implementing an application designed for paediatrics into an adult environment. The application required multiple adaptations to be more suited for adult ICU. This process was led by our clinical team in NHS Lothian
Significant restrictions on staff entering COVID-19 areas to provide training
Restrictions on large group teaching
New clinical protocols and procedures meaning significant changes to all areas of practice
Exceptional workload and demands on nursing staff limiting time they could dedicate to this new system
Concern over taking images of ventilated and sedated patients and issues around consent
Limited NHS Wi-Fi connection
More than 300 nursing staff in critical care between WGH and RIE to train

Despite these challenges the critical care teams in the Royal Infirmary of Edinburgh and the Western General Hospital embraced vCreate and quickly saw the hugely positive impact it could have for families, patients and staff.

Our Experience

Since we have introduced vCreate to NHS Lothian we have enrolled nearly 40 families and either sent or received 170 videos and 110 photos. This virtual connection between families and the critical care units has enabled them to be far more involved in their loved one’s ICU journey. They have seen the progression, both positive and negative, and gained a much better understanding of their time in ICU. Each family can decide what content they receive. Typically we feature the milestones of a critical care journey. Most families receive an update every few days which often consists of a nursing or medical update, an orientation to the monitors or machines by the bed space, and the opportunity to see their loved one. Additional video clips and photos will depend on the family wishes and clinical status of the patient. We have used vCreate to send video clips of the first time talking with a speaking valve, first time sitting upright in a chair, waving and even the first taste of ice cream after prolonged ventilation. This video content has provided a powerful source of reassurance to families and great sense of achievement for our patients. Our preliminary feedback from patient families has shown that it has reduced anxiety and they have found receiving photos reassuring and calming.

Sadly a significant number of patients died from COVID-19 disease. In the early stages of the pandemic relatives were finding it particularly challenging to accept how unwell their loved one was and also be confident that the critical care team had tried all treatments before discussing End of Life care. By sending regular visual updates of the patient’s progress it seemed to help families appreciate the severity of their illness and also have a much better understanding of the treatments that had been offered. We felt this helped better prepare families for End of Life discussions, whilst also helping staff members in dealing with such a challenging situation during the pandemic.

Future Aims

With such a positive experience during the implementation phase of vCreate across Scotland, we hope that vCreate will persist post-pandemic as an effective additional communication tool.

We are currently undertaking a Scottish Wide survey of staff to find out about the experience of implementing a new application like vCreate during such a challenging time. Following on from this we are excited to have been awarded the COVID-19 Special Research Grant from the British Academy to undertake a formal patient and family evaluation of the use of vCreate as part of family diaries. We hope this evaluation will reflect the positive engagement with the service we have experienced.

References

(1). R Pauldine, T Dorman (2006). Communication with Families in the ICU. ICU Management & Practice, ICU Volume 6 (2). URL:https://healthmanagement.org/c/icu/issuearticle/communication-with-families-in-the-icu

Authors: Tait JE, Thomson A, McCulloch C, Rodgers S, Tocher J, MacKinnon L, Wheelhouse M, Nunn K, Graham A, Jordan H, Abu-Arafeh A, Wilson E.