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New strategies to improve communication in the intensive care unit during the COVID-19 pandemic
Critical Care ( IF 15.1 ) Pub Date : 2022-06-28 , DOI: 10.1186/s13054-022-04057-2
Charlene Kit Zhen Chua _{1,

2}

Affiliation

Communication with patients’ family members in the intensive care unit (ICU) has been extremely challenging during the COVID-19 pandemic. Strict visitation policies present a significant barrier for healthcare practitioners to provide medical information, offer emotional support and build rapport with patients’ family members. As a result of being unable to see the patients at the bedside, family members can feel frustrated, depressed and anxious, affecting their own emotional and psychological well-being [1]. Two strategies that can be employed for effective communication with patients’ family members include the establishment of an ICU family liaison service and the use of videoconferencing.

The COVID-19 pandemic continues to take a huge toll on interpersonal communication among healthcare staff in the ICU. The application of face masks [2] and other personal protective equipment (PPE) [3], social distancing, work isolation and redeployment of staff can change the dynamics of team communication. Non-verbal communication methods such as hand signals [4] and the use of identification adjuncts to improve staff identification [5] have emerged as methods to address these challenges. In addition, the effect of these disruptions can be mitigated by the application of hands-free communication devices as well as the introduction of team roles and name labels.

ICU family liaison service

The ICU family liaison service is a new initiative started during the pandemic to ensure timely and effective communication with patients’ family members. The family liaison team is responsible for contacting every patient’s family within 24 h of ICU admission. The team notifies the family about the patient’s ICU admission, addresses immediate concerns, clarifies details of next-of-kin, offers information about the visitation process (including applicable restrictions) and provides contact details of the unit.

The team maintains contact and supports the family throughout the admission. Any concerns are escalated appropriately to specific services such as medical, allied health or social support departments. The sole responsibility in providing updates about a patient’s clinical progress and management plan lies with the medical staff. This is important to prevent miscommunication as the family liaison team is not involved in medical management of the patient.

The ICU family liaison service assists the medical team by ensuring the patients’ family members have convenient access to information regarding the ICU admission. The introduction of the family liaison team has been shown to reduce pressure on medical staff [6] and improve levels of satisfaction for patients’ family members [7].

Videoconferencing

Web-based videoconferencing has become a routine communication channel during the pandemic, particularly when family visits have not been allowed or were impractical (for example due to government-imposed ‘lockdowns’). Videoconferencing offers a remote virtual meeting opportunity for ‘real-time’ discussion between healthcare staff and patients’ family members [8]. It is the most practical alternative option to an in-person meeting or a phone call, especially when breaking bad news [9], delivering complex medical information or discussing goals of care.

Conscious and lucid patients in the ICU are encouraged to use videoconferencing to connect with their families to promote their emotional and psychological well-being. Other benefits of videoconferencing include preventing delirium, improving engagement with health services, providing mental support, enhancing staff morale and overcoming language barriers [10].

An initial nurse-led approach to facilitate a virtual walk-around of the patient’s bed space helps with the family’s understanding of the patient’s clinical status. This is followed by clinical updates from ICU medical staff. Specific concerns and questions can be further addressed at the end of the virtual visit. The timing and duration of the virtual visit are flexible. This practice provides reassurance, builds rapport and helps generate trust with the patient’s family.

Hands-free communication devices

The use of small, wearable, voice-activated, hands-free communication devices allows healthcare staff to connect and communicate instantly with their colleagues by identifying their names or roles. It helps to decrease the risk of infection by reducing the use of individual mobile phones and exposure to personal clothing [8]. It also saves time and PPE resources as direct assistance and support can be sought immediately without leaving the bed space. Hands-free conversations can be initiated and continued with no interruption to clinical tasks, improving work efficiency. The staff has control over its practical use by declining incoming calls when clinically inappropriate [11]. The correct use of hands-free communication devices has allowed staff to feel supported and stay connected despite working in a difficult and potentially isolating environment during the pandemic.

Team role and name labels

The use of PPE can impact communication and interaction among healthcare staff [12] and lead to difficulties recognising and identifying other staff [5]. Important aspects of communication such as facial expressions, clarity of voice and volume of speech are also negatively affected by PPE. The application of colour-coded team roles and name labels is a useful method to improve communication in this setting. The identification labels are usually attached over the hospital gowns at the donning station supervised by a ‘PPE monitor’. Names can be written over the top part of face shields. This method can be effective in a large intensive care unit, especially with staff redeployment and new staff recruitment. The use of labels as visual aids allows staff to recognise each other in a new working environment, promoting the efficient transfer of information and improving team dynamics. In resuscitation situations, it enables immediate identification of staff members for team role allocation.

ICU staff has had to innovate and develop new communication strategies to address the barriers brought about by the COVID-19 pandemic. This has resulted in a paradigm shift from the traditional communication methods used pre-pandemic. These strategies may be adapted in other intensive care units to improve patient families’ access to information and enhance staff communication and teamwork. Future studies should focus on refining, diversifying and innovating elements of formal and informal communication within the ICU considering workforce and workplace challenges due to COVID-19.

Not applicable.

ICU:: Intensive care unit
PPE:: Personal protective equipment

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The author is grateful to all medical practitioners, nurses, allied health professionals and support workers for their diligence and professionalism in providing high-quality care to every patient in the intensive care unit during the COVID-19 pandemic.

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Authors and Affiliations

Department of Intensive Care and Hyperbaric Medicine, Alfred Health, Melbourne, VIC, Australia
Charlene Kit Zhen Chua
School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
Charlene Kit Zhen Chua

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The author confirms sole responsibility for the design of the commentary and manuscript preparation. The author read and approved the final manuscript.

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Correspondence to Charlene Kit Zhen Chua.

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Chua, C.K.Z. New strategies to improve communication in the intensive care unit during the COVID-19 pandemic. Crit Care 26, 191 (2022). https://doi.org/10.1186/s13054-022-04057-2

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Received: 18 April 2022
Accepted: 07 June 2022
Published: 28 June 2022
DOI: https://doi.org/10.1186/s13054-022-04057-2

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Keywords

Communication
COVID-19
Family liaison service
Hands-free communication device
Intensive care
Role labels
Videoconferencing

中文翻译：

在 COVID-19 大流行期间改善重症监护室沟通的新策略

在 COVID-19 大流行期间，与重症监护病房 (ICU) 患者家属的沟通极具挑战性。严格的探视政策为医疗保健从业人员提供医疗信息、提供情感支持以及与患者家属建立融洽关系构成了重大障碍。由于无法在床边看到病人，家属会感到沮丧、沮丧和焦虑，影响他们自己的情绪和心理健康[1]。可用于与患者家属有效沟通的两种策略包括建立 ICU 家庭联络服务和使用视频会议。

COVID-19 大流行继续对 ICU 医护人员之间的人际沟通造成巨大损失。口罩 [2] 和其他个人防护设备 (PPE) [3] 的应用、社交距离、工作隔离和员工重新部署可以改变团队沟通的动力。非语言交流方法，如手势 [4] 和使用识别辅助工具来提高员工识别能力 [5] 已成为应对这些挑战的方法。此外，这些中断的影响可以通过免提通信设备的应用以及团队角色和名称标签的引入来减轻。

ICU家庭联络服务

ICU家属联络服务是疫情期间启动的一项新举措，旨在确保与患者家属及时有效沟通。家庭联络小组负责在 ICU 入院后 24 小时内联系每位患者的家属。该团队将患者入住 ICU 的情况通知家属，解决直接关注的问题，澄清近亲的详细信息，提供有关探视过程的信息（包括适用的限制）并提供单位的联系方式。

该团队在整个入院期间保持联系并为家人提供支持。任何疑虑都会适当升级到特定服务部门，例如医疗、专职医疗或社会支持部门。提供有关患者临床进展和管理计划的最新信息的唯一责任在于医务人员。这对于防止误解很重要，因为家庭联络小组不参与患者的医疗管理。

ICU 家庭联络服务通过确保患者家属能够方便地获取有关 ICU 入院的信息来协助医疗团队。家庭联络小组的引入已被证明可以减轻医务人员的压力 [6] 并提高患者家属的满意度 [7]。

视频会议

在大流行期间，基于网络的视频会议已成为一种常规的沟通渠道，尤其是在不允许探亲或不切实际（例如由于政府实施的“封锁”）时。视频会议为医护人员和患者家属之间的“实时”讨论提供了远程虚拟会议机会 [8]。这是面对面会议或电话最实用的替代选择，尤其是在发布坏消息 [9]、提供复杂的医疗信息或讨论护理目标时。

鼓励 ICU 中清醒和清醒的患者使用视频会议与家人联系，以促进他们的情绪和心理健康。视频会议的其他好处包括预防谵妄、改善与卫生服务的参与、提供精神支持、提高员工士气和克服语言障碍 [10]。

最初由护士主导的方法可以促进患者床位的虚拟走动，这有助于家人了解患者的临床状况。随后是 ICU 医务人员的临床更新。虚拟访问结束时可以进一步解决具体问题和问题。虚拟访问的时间和持续时间是灵活的。这种做法提供了保证，建立了融洽的关系，并有助于与患者家属建立信任。

免提通讯设备

使用小型、可穿戴、声控、免提通信设备，医护人员可以通过识别他们的姓名或角色与他们的同事即时联系和沟通。它通过减少个人手机的使用和接触个人衣物来帮助降低感染风险 [8]。它还可以节省时间和 PPE 资源，因为无需离开床位即可立即寻求直接帮助和支持。可以在不中断临床任务的情况下发起和继续免提对话，从而提高工作效率。当临床不合适时，工作人员可以通过拒绝来电来控制其实际使用 [11]。

团队角色和名称标签

PPE 的使用会影响医护人员之间的沟通和互动 [12]，并导致难以识别和识别其他工作人员 [5]。PPE 也会对沟通的重要方面产生负面影响，例如面部表情、语音清晰度和音量。使用颜色编码的团队角色和名称标签是在这种情况下改善沟通的有用方法。识别标签通常贴在穿衣站的病号服上，由“PPE 监视器”监督。名字可以写在面罩的顶部。这种方法在大型重症监护病房中非常有效，尤其是在人员重新部署和新员工招聘时。使用标签作为视觉辅助工具可以让员工在新的工作环境中相互识别，促进信息的有效传递，提高团队活力。在复苏情况下，它可以立即识别工作人员以进行团队角色分配。

ICU 工作人员不得不创新和制定新的沟通策略，以解决 COVID-19 大流行带来的障碍。这导致了大流行前使用的传统通信方法的范式转变。这些策略可能会在其他重症监护病房进行调整，以改善患者家属获取信息并加强员工沟通和团队合作。考虑到 COVID-19 带来的劳动力和工作场所挑战，未来的研究应侧重于改进、多样化和创新 ICU 内正式和非正式沟通的要素。

不适用。

重症监护室：: 重症监护室
个人防护装备：: 个人保护设备

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作者感谢所有医生、护士、专职医疗人员和支持人员，感谢他们在 COVID-19 大流行期间为重症监护病房的每位患者提供高质量护理的勤奋和专业精神。

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重症监护和高压医学部，Alfred Health，墨尔本，维多利亚州，澳大利亚
Charlene Kit 甄嬛
澳大利亚新南威尔士州纽卡斯尔纽卡斯尔大学医学与公共卫生学院
Charlene Kit 甄嬛

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