Developing an Innovative System of Open and Flexible, Patient-Family-Centered, Virtual Visiting in ICU During the COVID-19 Pandemic: A Collaboration of Staff, Patients, Families, and Technology Companies

Abstract

Few challenges of the COVID-19 pandemic strike at the very core of our humanity as the inability of family to sit at the bedside of their loved ones when battling for their lives in the ICU. Virtual visiting is one tool to help deal with this challenge. When introducing virtual visiting into our ICU, we identified 5 criteria for a sustainable system that aligned with patient-family-centered care: virtual visiting needed to (1) simulate open and flexible visiting; (2) be able to accommodate differences in family size, dynamics, and cultural practices; (3) utilize a video conferencing platform that is private and secure; (4) be easy to use and not require special teams to facilitate meetings; and (5) not increase the workload of ICU staff. There is a growing body of literature demonstrating a global movement toward virtual visiting in ICU, however there are no publications that describe a system which meet all 5 of our criteria. Importantly, there are no papers describing systems of virtual visiting which mimic open and flexible family presence at the bedside. We were unable to find any off-the-shelf video conferencing platforms that met all our criteria. To come up with a solution, a multidisciplinary team of ICU staff partnered with healthcare technology adoption consultants and two technology companies to develop an innovative system called HowRU. HowRU uses the video conferencing platform Webex with the integration of some newly designed software that automates many of the laborious and complex processes. HowRU is a cloud based, supported, and simplified system that closely simulates open and flexible visiting while ensuring patient and family privacy, dignity, and security. We have demonstrated the transferability of HowRU by implanting it into a second ICU. HowRU is now commercially available internationally. We hope HowRU will improve patient-family-centered care in ICU.

Family experiences and perceptions of intensive care unit care and communication during the COVID-19 pandemic

“…3,62 Telehealth was used to connect with some families; however, as previously reported, it was found that there was some resistance from staff members who felt that they were too busy, the system was not user-friendly, or devices were not readily available. 57,63,64 Innovative technology such as the Virtual Intensive Care Unit which electronically connects families and patients via smart phones and has the potential to improve communication between patient, clinician, and the family is being developed 2,63,65,66 and may be more available in the future. Communication via phone and telehealth is valuable, but the trauma inherent in having a close family member critically unwell is overwhelming, making any substitute for personal contact inadequate.…”

“…These visiting restrictions have challenged the role of the family in patient care and recovery and have had a distressing impact on many families. 2 Families normally play a pivotal role in the care of patients in the intensive care unit (ICU), providing emotional support, surrogate decision-making, and patient advocacy. 3 Visiting restrictions have kept families and patients apart, causing additional trauma to many.…”

Adult Experiences with Hospitalization in Alberta, Canada During the COVID-19 Pandemic: A Comparative Cross-Sectional Study

“…Although we did not observe similar results as Zeh et al with respect to discharge planning, we advocate for the necessity of novel ways to involve family members and friends (who may also play active roles as caregivers) in care decisions during times of physical hospital restrictions. As an example, the feasibility of a family centered, virtual visiting strategy in the ICU was recently highlighted by Thomas et al This strategy was successful in satisfying five essential criteria that virtual visiting needed to (1) simulate open and flexible visiting; (2) be able to accommodate differences in family size, dynamics, and cultural practices; (3) utilize a video conferencing platform that is private and secure; and (4) be easy to use and not require special teams to facilitate meetings; and (5) not increase the workload of ICU staff (21).…”

A Modified Delphi Process to Prioritize Experiences and Guidance Related to ICU Restricted Visitation Policies During the Coronavirus Disease 2019 Pandemic

“…A teleconferencing initiative during the COVID-19 pandemic (Life Lines) that used simple, intuitive technology that functions independent of the hospital Wi-Fi, still encountered barriers, especially insufficient staff time to prepare virtual communication ( 32 ). Research is emerging on how best to implement video conferencing platforms into ICUs ( 36 ).…”