Tech in ICUs: A personal connection when physical contact isn’t possible

Dr Ian Jackson speaks from experience when he says technology could be better used in intensive care units to connect families with loved ones – now, during the Covid-19 crisis, more than ever. He spoke to Digital Health’s Andrea Downey on the role digital has to play in intensive care.

Losing a loved one is never easy and being able to see them in hospital and talk to their clinical team provides a level of comfort and understanding many of us need.

But in some cases, particularly during the Covid-19 pandemic, these empathetic connections aren’t possible as it’s too risky to visit patients in intensive care units (ICU). Or, in other cases, you simply don’t make it in time.

Dr Jackson, medical director and clinical safety officer at Refero, knows firsthand how that feels. In 2000 his dad, Peter Jackson, died after falling through a roof on his farm in Aberdeen, Scotland.

Based at York Teach Hospitals NHS Foundation Trust at the time, Dr Jackson received a call from an ICU clinician treating his father and raced up to Scotland to see him. In a cruel twist of fate, during that time his dad’s health deteriorated and he died on the ICU ward before having a chance to say goodbye.

Empathy to drive communications

That feeling of empathy and understanding is what drives Dr Jackson’s vision to see ICU wards equipped with better communications technology.

“He was up in Scotland and I couldn’t get there in time. I got the phone call from an intensitive I knew, I’d looked after his mother years ago, and he said ‘I’d hoped I’d be able to do the things you did for my mum’, he was so upset,” Dr Jackson tells Digital Health News.

“I suspect that’s one of the reasons I jumped on this quite quickly and said to the team we need to be working on something that allows people to connect, because it is a very real concern.”

Addressing security concerns

Currently, he says, most ICUs are relying on apps like Facetime of Skype to connect with families of Covid patients, as they cannot come to visit. But that raises governance and security concerns as the apps are not designed for sensitive medical use.

That’s not the fault of NHS staff, he explains, adding that they’re doing everything necessary to care for patients and families in an unprecedent situation. The rapport between ICU nurses, clinicians and family members is vital, it provides a support and understanding at a time that is often confusing and distressing.

Dr Jackson believes technology companies like Refero, a video and voice platform that provides connections between clinicians and patients, have a role to play in keeping ICUs connected.

“If you think of a normal situation where a patient is admitted to intensive care, their relatives come with the patient and wait in the waiting room to be talked to by the medical and nursing staff, to be told what they can expect to see when they go inside and a discussion about what is happening,” he says.

“At some stage it’s most likely you have the family with the patient. That’s an important time because the nursing staff are with the patient and have a chance to chat to the relatives and help provide support and answer any questions they’ve got.

“The nursing staff and medical staff develop a rapport with the relatives which is really important. You are dealing with relatives all the time, and it’s face-to-face, so there’s a huge empathetic component. That link is part of the process of helping the relatives come to terms with what’s happened.”

Redesigning the system

But the onset of coronavirus has made the usual way of working all but impossible, with relatives only able to receive updates about their loved ones by phone, or apps that aren’t designed to be used in a hospital.

Ward staff and clinicians are also incredibly stretched for time and often aren’t able to answer the phone or return a call for a number of hours, which leaves family members waiting at home anxious for news.

“You can imagine that’s a huge chasm, communicating by telephone and not having that link to the nursing staff. It’s a tragic situation,” Dr Jackson adds.

“In an ideal world you would have a secure route for communicating with relatives, so you would be able to recruit them onto a system that allows the medical team to link to these individuals.

“I think it’s more than video technology, it’s messaging as well. We use messaging much more these days as individuals, we should have the ability to to send messages instead of having constant phone calls to intensive care.

“If you had the ability to use two-way messaging to the staff, and administrate that messaging so it goes to the most appropriate person to answer the question, then you can start to build up that rapport.”

Secure connections

Dr Jackson explains a platform like Refero’s could be reverse engineered to take it from being patient facing, as often in ICU patients are too unwell to use it, to being a secure connection between clinicians and family, in a way that works for them.

Eventually, the platform could be built upon to include pre-recorded video messages and photos from relatives and also from the patient to family and friends, Dr Jackson says.

The ability to quickly and securely contact ICU staff, he says, will not only benefit the mental health of families waiting for news but also help bridge the gap of wondering why something went wrong in the event a patient doesn’t make it.

It also helps boost patient morale at one of the most emotional and confronting times of their lives.

“The difference between having a team communicating regularly with relatives and bringing them along on the journey and having that separation and someone dying in hospital with no one there, that’s a huge divide,” Dr Jackson says.

“It’s vital in intensive care. It’s not just about the mental health of the relatives, it’s about ensuring we have that ongoing contact.”