Difference between revisions of "Virtual visitation"
| Line 2: | Line 2: | ||
== Overview == | == Overview == | ||
| − | Virtual visitation usually occurs between a patient who is admitted to a healthcare facility and their friends or family who are unable to visit the healthcare facility in person. The visit can be for emotional and social support<ref name="abel">Abel J, Taubert M. Coronavirus pandemic: compassionate communities and information technology. BMJ Support Palliat Care. 2020.</ref>, or to facilitate medical decision making with, or on behalf of, the patient. In some cases, more than two parties can be on the call using video conferencing technology. The involvement of the healthcare team in such calls may also be called telerounding (occurring during daily rounds, for example) or virtual family meeting (occurring with the patient and healthcare team at a time separate from daily rounds). | + | Virtual visitation usually occurs between a patient who is admitted to a healthcare facility and their friends or family who are unable to visit the healthcare facility in person. The visit can be for emotional and social support<ref name="abel">Abel J, Taubert M. Coronavirus pandemic: compassionate communities and information technology. BMJ Support Palliat Care. 2020.</ref>, or to facilitate medical decision making with, or on behalf of, the patient. In some cases, more than two parties can be on the call using video conferencing technology. The involvement of the healthcare team in such calls may also be called telerounding (occurring during daily rounds, for example) or virtual family meeting (occurring with the patient and healthcare team at a time separate from daily rounds). Prior to the COVID-19 pandemic, there was limited evidence regarding the use of video calls to reduce social isolation and loneliness.<ref name="noone">Noone C, McSharry J, Smalle M, Burns A, Dwan K, Devane D, et al. Video calls for reducing social isolation and loneliness in older people: a rapid review. Cochrane Database Syst Rev. 2020;5:CD013632.</ref> |
During the COVID-19 pandemic, most hospitals and other healthcare facilities (such as nursing homes and assisted living facilities) restricted visitation from family and friends in order to limit transmission of the SARS-CoV-2 virus. Such restrictions prompted many facilities to implement virtual visitation to provide meaningful communication between patients and their loved ones. Although concern over privacy and security issues still exist<ref name="wakam">Wakam GK, Montgomery JR, Biesterveld BE, Brown CS. Not Dying Alone — Modern Compassionate Care in the Covid-19 Pandemic. New England Journal of Medicine. 2020;382(24). </ref>, the flexibilities on HIPAA during the COVID-19 public health emergency<ref name="hhs">[https://www.hhs.gov/hipaa/for-professionals/special-topics/hipaa-covid19/index.html HIPAAA and COVID-19 | HHS.gov] - accessed October 20, 2020</ref> has eased concerns over the use of video-calling technologies. | During the COVID-19 pandemic, most hospitals and other healthcare facilities (such as nursing homes and assisted living facilities) restricted visitation from family and friends in order to limit transmission of the SARS-CoV-2 virus. Such restrictions prompted many facilities to implement virtual visitation to provide meaningful communication between patients and their loved ones. Although concern over privacy and security issues still exist<ref name="wakam">Wakam GK, Montgomery JR, Biesterveld BE, Brown CS. Not Dying Alone — Modern Compassionate Care in the Covid-19 Pandemic. New England Journal of Medicine. 2020;382(24). </ref>, the flexibilities on HIPAA during the COVID-19 public health emergency<ref name="hhs">[https://www.hhs.gov/hipaa/for-professionals/special-topics/hipaa-covid19/index.html HIPAAA and COVID-19 | HHS.gov] - accessed October 20, 2020</ref> has eased concerns over the use of video-calling technologies. | ||
| Line 8: | Line 8: | ||
==Technology== | ==Technology== | ||
Virtual visitation requires technology to facilitate the visit. Both the patient (or healthcare facility where the patient is admitted) and the family or friends need to have the hardware, software, and adequate bandwidth for a successful visit to occur. Additionally, the ability to operate and troubleshoot the hardware and software on both ends of the call is required.<ref name="bmjblog">[https://blogs.bmj.com/spcare/2020/03/15/using-skype-during-pandemic-isolation/ Using Skype during Pandemic Isolation - BMJ Supportive & Palliative Care] - accessed October 17, 2020</ref> | Virtual visitation requires technology to facilitate the visit. Both the patient (or healthcare facility where the patient is admitted) and the family or friends need to have the hardware, software, and adequate bandwidth for a successful visit to occur. Additionally, the ability to operate and troubleshoot the hardware and software on both ends of the call is required.<ref name="bmjblog">[https://blogs.bmj.com/spcare/2020/03/15/using-skype-during-pandemic-isolation/ Using Skype during Pandemic Isolation - BMJ Supportive & Palliative Care] - accessed October 17, 2020</ref> | ||
| + | |||
===Hardware=== | ===Hardware=== | ||
| − | Frequently, patients have their own smartphone, tablet, or laptop computer with them at the healthcare facility. However, when hardware is unavailable or the patient is unable to operate the hardware (for example, due to severity of illness), then some healthcare facilities are able to provide hardware, often in the form of a tablet, for the patient to use. If tablets must be shared among patients, then appropriate device cases and standardized protocols for cleaning the device between uses must be developed.<ref name="ritchey">Ritchey KC, Foy A, Mcardel E, Gruenewald DA. Reinventing Palliative Care Delivery in the Era of COVID-19: How Telemedicine Can Support End of Life Care. American Journal of Hospice and Palliative Medicine®. 2020;37(11): | + | Frequently, patients have their own smartphone, tablet, or laptop computer with them at the healthcare facility. However, when hardware is unavailable or the patient is unable to operate the hardware (for example, due to severity of illness), then some healthcare facilities are able to provide hardware, often in the form of a tablet, for the patient to use. If tablets must be shared among patients, then appropriate device cases and standardized protocols for cleaning the device between uses must be developed.<ref name="ritchey">Ritchey KC, Foy A, Mcardel E, Gruenewald DA. Reinventing Palliative Care Delivery in the Era of COVID-19: How Telemedicine Can Support End of Life Care. American Journal of Hospice and Palliative Medicine®. 2020;37(11):992-7.</ref> Other types of hardware include computers or workstations on wheels which can be brought into the patient's room on demand<ref name="rosenbluth">Rosenbluth G, Good BP, Litterer KP, Markle P, Baird JD, Khan A, et al. Communicating Effectively With Hospitalized Patients and Families During the COVID-19 Pandemic. J Hosp Med. 2020;15(7):440-2.</ref>, or the use of existing monitoring technology such as virtual intensive care unit<ref name="sasangohar">Sasangohar F, Dhala A, Zheng F, Ahmadi N, Kash B, Masud F. Use of telecritical care for family visitation to ICU during the COVID-19 pandemic: an interview study and sentiment analysis. BMJ Qual Saf. 2020.</ref>. The devices may be able to be repurposed from other uses, otherwise they must be purchased by the facility or donated to the facility.<ref name="salway">Salway RJ, Silvestri D, Wei EK, Bouton M. Using Information Technology To Improve COVID-19 Care At New York City Health + Hospitals. Health Affairs. 2020;39(9):1601-4.</ref> Occasionally when none of these options are available, members of the healthcare team have offered the use of their own personal device.<ref name="mercadante" /> The patient’s family and friends must have access to and be able to operate their own device. |
| + | |||
===Software=== | ===Software=== | ||
A number of readily available video calling apps have been utilized for virtual visitation, including Skype, WhatsApp, FaceTime, Zoom, and Google Hangouts. The specific app that is used should take into consideration the type of device (e.g. FaceTime is only available for Apple products) that is available to all parties. Video conferencing capabilities may allow for more family members to join the visitation simultaneously, provide interpreter support, and allow for virtual family meetings.<ref name="lin" />There have also been privacy and security concerns with regard to some of the video calling apps. | A number of readily available video calling apps have been utilized for virtual visitation, including Skype, WhatsApp, FaceTime, Zoom, and Google Hangouts. The specific app that is used should take into consideration the type of device (e.g. FaceTime is only available for Apple products) that is available to all parties. Video conferencing capabilities may allow for more family members to join the visitation simultaneously, provide interpreter support, and allow for virtual family meetings.<ref name="lin" />There have also been privacy and security concerns with regard to some of the video calling apps. | ||
Asynchronous videoconferencing technology has also been used to video-record rounding for families to review at another time.<ref name="billingsley">Billingsley L. Using Video Conferencing Applications to Share the Death Experience During the COVID-19 Pandemic. J Radiol Nurs. 2020.</ref> | Asynchronous videoconferencing technology has also been used to video-record rounding for families to review at another time.<ref name="billingsley">Billingsley L. Using Video Conferencing Applications to Share the Death Experience During the COVID-19 Pandemic. J Radiol Nurs. 2020.</ref> | ||
| + | |||
===Bandwidth=== | ===Bandwidth=== | ||
| − | Both parties must have adequate bandwidth to support the video call, which includes both download and upload speeds. If videoconferencing (i.e. more than two parties) is desired, then more bandwidth may also be needed. In situations where there is heavy simultaneous use of videoconferencing, for example during the COVID-19 pandemic, then the bandwidth must be even greater to support all of the calls. | + | Both parties must have adequate bandwidth to support the video call, which includes both download and upload speeds. If videoconferencing (i.e. more than two parties) is desired, then more bandwidth may also be needed. In situations where there is heavy simultaneous use of videoconferencing, for example during the COVID-19 pandemic, then the bandwidth must be even greater to support all of the calls. There must be attention to latency times whether due to connection limits or device limitations.<ref name="negro" /> |
| − | + | ||
| − | There must be | + | |
===Personnel=== | ===Personnel=== | ||
| − | Even with the availability of the above technologies, the availability of personnel to assist with the use of the technology can be a limitation in the utility of virtual visitation. Due to infection control concerns and limited personal protective equipment (PPE) supplies, there may be limited ability for nurses or other caregivers to enter patient rooms to assist with virtual visitation. Additionally, having a nurse assist with video visitation and troubleshooting prevents that nurse from caring for their other patients.<ref name="goulabchand">Goulabchand R, Boclé H, Vignet R, Sotto A, Loubet P. Digital tablets to improve quality of life of COVID-19 older inpatients during lockdown. Eur Geriatr Med. 2020;11(4):705-6.</ref> However, some hospitals have addressed this need by redeploying healthcare workers from other settings.<ref name="billingsley" /><ref name="metrohealth">[https://vimeo.com/404776890 MetroHealth's Compassionate Care Rounders] (video) - accessed October 17, 2020</ref> | + | Even with the availability of the above technologies, the availability of personnel to assist with the use of the technology can be a limitation in the utility of virtual visitation. There must be at least one person on each end of the video call or video conference who is able to operate the device and make the connection to the call, and also be able to troubleshoot if there are any problems which occur with starting the call or during the call. Due to infection control concerns and limited personal protective equipment (PPE) supplies, there may be limited ability for nurses or other caregivers to enter patient rooms to assist with virtual visitation. Additionally, having a nurse assist with video visitation and troubleshooting prevents that nurse from caring for their other patients.<ref name="goulabchand">Goulabchand R, Boclé H, Vignet R, Sotto A, Loubet P. Digital tablets to improve quality of life of COVID-19 older inpatients during lockdown. Eur Geriatr Med. 2020;11(4):705-6.</ref> However, some hospitals have addressed this need by redeploying healthcare workers from other settings.<ref name="billingsley" /><ref name="metrohealth">[https://vimeo.com/404776890 MetroHealth's Compassionate Care Rounders] (video) - accessed October 17, 2020</ref> |
In addition to availability of personnel, training of personnel is required to not only be technically facile, but also develop good communication skills specific to video-calling. Such skills are particularly applicable for telemedicine, but equally important for telerounding and virtual family meetings, and are helpful to setting up virtual visitation between patient and loved ones.<ref name="lin" /><ref name="chua">Chua IS, Jackson V, Kamdar M. Webside Manner during the COVID-19 Pandemic: Maintaining Human Connection during Virtual Visits. J Palliat Med. 2020.</ref> Patients and families should also be informed about the limitations of the technology.<ref name="goulabchand" /> | In addition to availability of personnel, training of personnel is required to not only be technically facile, but also develop good communication skills specific to video-calling. Such skills are particularly applicable for telemedicine, but equally important for telerounding and virtual family meetings, and are helpful to setting up virtual visitation between patient and loved ones.<ref name="lin" /><ref name="chua">Chua IS, Jackson V, Kamdar M. Webside Manner during the COVID-19 Pandemic: Maintaining Human Connection during Virtual Visits. J Palliat Med. 2020.</ref> Patients and families should also be informed about the limitations of the technology.<ref name="goulabchand" /> | ||
| Line 25: | Line 27: | ||
==Healthcare settings== | ==Healthcare settings== | ||
Virtual visitation has been implemented in different healthcare settings and for different purposes, including by palliative care teams, neonatal intensive care, and other intensive care units.<ref name="lin">Lin CT, Bookman K, Sieja A, Markley K, Altman RL, Sippel J, et al. Clinical Informatics Accelerates Health System Adaptation to the COVID-19 Pandemic: Examples from Colorado. J Am Med Inform Assoc. 2020.</ref> Some examples of adaptations for specific needs are described in this section. | Virtual visitation has been implemented in different healthcare settings and for different purposes, including by palliative care teams, neonatal intensive care, and other intensive care units.<ref name="lin">Lin CT, Bookman K, Sieja A, Markley K, Altman RL, Sippel J, et al. Clinical Informatics Accelerates Health System Adaptation to the COVID-19 Pandemic: Examples from Colorado. J Am Med Inform Assoc. 2020.</ref> Some examples of adaptations for specific needs are described in this section. | ||
| + | |||
===Pediatrics=== | ===Pediatrics=== | ||
| + | Some authors suggest that telerounding may have benefits for the pediatric population, particularly if it limits the number of healthcare providers in the room to those the patient has most comfort around, as patients can be uncomfortable advocating for themselves in front of healthcare personnel they do not know very well.<ref name="rosenbluth" /> | ||
| + | |||
| + | ====Neonatal intensive care==== | ||
| + | Families who are able to use virtual visitation to see their newborns in the neonatal intensive care unit (NICU) have expressed appreciation of being able to see their infant, felt that visualizing their infant reduced their own stress and anxiety, and provided reassurance that their infant was doing well. However a minority of patients also felt guilt that they were unable to be with their infant when they viewed them on camera. Overall video visitation was found to be helpful and meaningful.<ref name="murray">Murray PD, Swanson JR. Visitation restrictions: is it right and how do we support families in the NICU during COVID-19? J Perinatol. 2020;40(10):1576-81.</ref> | ||
| + | |||
===Intensive care units=== | ===Intensive care units=== | ||
| + | Some have suggested the development of a checklist (similar to other checklists used in the intensive care unit) to ensure high quality video calling takes place, including recommendations for the set up of the technology and the call, and attention to setting. For example, the visual impact of the patient in the intensive care setting who may be in prone position, with many lines and tubes, etc.<ref name="negro">Negro A, Mucci M, Beccaria P, Borghi G, Capocasa T, Cardinali M, et al. Introducing the Video call to facilitate the communication between health care providers and families of patients in the intensive care unit during COVID-19 pandemia. Intensive Crit Care Nurs. 2020;60:102893.</ref> | ||
===Palliative care and hospice=== | ===Palliative care and hospice=== | ||
| + | |||
===Long-term care facilities=== | ===Long-term care facilities=== | ||
Patients and residents of long-term care facilities, such as skilled nursing facilities and assisted living facilities, rely heavily on visitation from loved ones for both social interaction, advocacy, and assistance with care. This is especially true of patients with dementia. Video visitation can be used to facilitate daily visitation, however this necessitates more staff time, possible wifi upgrades or acquisition of technology (for example, adaptive communications technologies). Although skilled nursing facilities are able to use Centers for Medicare and Medicaid Services (CMS) funding to implement such services, assisted living facilities do not have access to such funding.<ref name="dobbs">Dobbs D, Peterson L, Hyer K. The Unique Challenges Faced by Assisted Living Communities to Meet Federal Guidelines for COVID-19. J Aging Soc Policy. 2020;32(4-5):334-42.</ref> | Patients and residents of long-term care facilities, such as skilled nursing facilities and assisted living facilities, rely heavily on visitation from loved ones for both social interaction, advocacy, and assistance with care. This is especially true of patients with dementia. Video visitation can be used to facilitate daily visitation, however this necessitates more staff time, possible wifi upgrades or acquisition of technology (for example, adaptive communications technologies). Although skilled nursing facilities are able to use Centers for Medicare and Medicaid Services (CMS) funding to implement such services, assisted living facilities do not have access to such funding.<ref name="dobbs">Dobbs D, Peterson L, Hyer K. The Unique Challenges Faced by Assisted Living Communities to Meet Federal Guidelines for COVID-19. J Aging Soc Policy. 2020;32(4-5):334-42.</ref> | ||
| + | |||
| + | In a cross sectional survey of 161 participants who have loved ones residing in long-term care facilities, virtual visitation had no effect on participant or patient positive or negative emotions. The authors hypothesized that unfamiliarity of the technology (particularly for the elderly) may be contributing to lack of a positive effect, as compared with familiar technology such as the telephone.<ref name="monin">Monin JK, Ali T, Syed S, Piechota A, Lepore M, Mourgues C, et al. Family Communication in Long-Term Care During a Pandemic: Lessons for Enhancing Emotional Experiences. Am J Geriatr Psychiatry. 2020.</ref> | ||
==Reception== | ==Reception== | ||
| − | In one study of patients in an intensive care unit, family members virtually visited through video-calling. Surveys of the family members revealed universal appreciation of the information, courtesy, and initiative taken by the healthcare team, and felt that having regular contact with both the patient and healthcare team alleviated the suffering of both the patient and the family. However, families wished for increased frequency of contact, and other means of updates.<ref name="carlucci">Carlucci M, Carpagnano LF, Dalfino L, Grasso S, Migliore G. Stand by me 2.0. Visits by family members at Covid-19 time. Acta Biomed. 2020;91(2):71-4.</ref> | + | In one study of patients in an intensive care unit, family members virtually visited through video-calling. Surveys of the family members revealed universal appreciation of the information, courtesy, and initiative taken by the healthcare team, and felt that having regular contact with both the patient and healthcare team alleviated the suffering of both the patient and the family. However, families wished for increased frequency of contact, and other means of updates.<ref name="carlucci">Carlucci M, Carpagnano LF, Dalfino L, Grasso S, Migliore G. Stand by me 2.0. Visits by family members at Covid-19 time. Acta Biomed. 2020;91(2):71-4.</ref> In another study, family members were interviewed after using WhatsApp video calling during clinical rounds (telerounding) at a palliative care and hospice center. Family members expressed that they were happy to attend rounds via WhatsApp, happy with the information gained, and they thought their loved one (patient) was happy to see them. However, they did not feel that the technology substituted their presence.<ref name="mercadante">Mercadante S, Adile C, Ferrera P, Giuliana F, Terruso L, Piccione T. Palliative Care in the Time of COVID-19. J Pain Symptom Manage. 2020;60(2):e79-e80.</ref> |
Others have reported that virtual visitations were meaningful for patients and families, and helped patients increase compliance with the healthcare team. Some have recommended that virtual visitation start as soon as possible during the hospital course, due to the possibility of rapid decline in clinical status.<ref name="goulabchand" /> | Others have reported that virtual visitations were meaningful for patients and families, and helped patients increase compliance with the healthcare team. Some have recommended that virtual visitation start as soon as possible during the hospital course, due to the possibility of rapid decline in clinical status.<ref name="goulabchand" /> | ||
In one case report, a survey to the surviving wife and son of a patient who died of COVID-19 revealed that the intervention of a video visitation to allow the family to say 'goodbye' to the patient gave the family some relief.<ref name="galazzi">Galazzi A, Brioni M, Mistraletti G, Roselli P, Abbruzzese C. End of life in the time of CoViD-19: the last farewell by video call. Minerva Anestesiol. 2020.</ref> | In one case report, a survey to the surviving wife and son of a patient who died of COVID-19 revealed that the intervention of a video visitation to allow the family to say 'goodbye' to the patient gave the family some relief.<ref name="galazzi">Galazzi A, Brioni M, Mistraletti G, Roselli P, Abbruzzese C. End of life in the time of CoViD-19: the last farewell by video call. Minerva Anestesiol. 2020.</ref> | ||
| − | Criticism of the use of virtual visitation primarily centers on its use as a substitute for in person visitation, as an argument against the visitation restrictions at healthcare facilities. <p><q>Setting up an iPad to prevent patients from dying alone is not a solution.</q><ref name="andrist"> | + | Additionally, a benefit of the video visitation is the potential to reduce psychological distress among clinicians.<ref name="salway" /> |
| + | |||
| + | Some of the limitations of video technology include delays (e.g. latency), technical difficulties, limitations of scheduling, lack of eye contact, limited nonverbal cues, and lack of physical touch<ref name="sasangohar" />. Virtual reality platforms may be able to bridge some of these shortcomings.<ref name="riva">Riva G, Mantovani F, Wiederhold BK. Positive Technology and COVID-19. Cyberpsychol Behav Soc Netw. 2020;23(9):581-7.</ref> Criticism of the use of virtual visitation primarily centers on its use as a substitute for in person visitation, as an argument against the visitation restrictions at healthcare facilities. Existing disparities may further be exacerbated as underserved communities are likely to have less access to technology, and digital communication may not be conducive to different communication styles.<ref name="valley">Valley TS, Schutz A, Nagle MT, Miles LJ, Lipman K, Ketcham SW, et al. Changes to Visitation Policies and Communication Practices in Michigan ICUs during the COVID-19 Pandemic. Am J Respir Crit Care Med. 2020;202(6):883-5.</ref><ref name="sher">Sher T, Stamper GC, Lundy LB. COVID-19 and Vulnerable Population With Communication Disorders. Mayo Clin Proc. 2020;95(9):1845-7.</ref><p><q>Setting up an iPad to prevent patients from dying alone is not a solution.</q><ref name="andrist"> | ||
Andrist E, Clarke RG, Harding M. Paved With Good Intentions: Hospital Visitation Restrictions in the Age of Coronavirus Disease 2019. Pediatr Crit Care Med. 2020;21(10):e924-e6. | Andrist E, Clarke RG, Harding M. Paved With Good Intentions: Hospital Visitation Restrictions in the Age of Coronavirus Disease 2019. Pediatr Crit Care Med. 2020;21(10):e924-e6. | ||
</ref> | </ref> | ||
| Line 43: | Line 57: | ||
[[Telemedicine]] – video calling technology used to conduct a healthcare encounter between a patient and a healthcare provider. | [[Telemedicine]] – video calling technology used to conduct a healthcare encounter between a patient and a healthcare provider. | ||
| − | ==Notes== | + | <!-- ==Notes== --> |
==References== | ==References== | ||
<references /> | <references /> | ||
| Line 50: | Line 64: | ||
[https://www.kaweahdelta.org/COVID19/Virtual-Visitations.aspx Kaweah Delta Virtual Visitations] - example of virtual visitation implemented at one hospital. | [https://www.kaweahdelta.org/COVID19/Virtual-Visitations.aspx Kaweah Delta Virtual Visitations] - example of virtual visitation implemented at one hospital. | ||
| − | Submitted by Da Jin --[[User:Dpjin|Dpjin]] ([[User talk:Dpjin|talk]]) | + | Submitted by Da Jin --[[User:Dpjin|Dpjin]] ([[User talk:Dpjin|talk]]) 21:59, 20 October 2020 (UTC) |
[[Category:BMI512-FALL-20]] | [[Category:BMI512-FALL-20]] | ||
Revision as of 21:59, 20 October 2020
Virtual visitation, also known as virtual visits and video visits, is the use of video calling technology to facilitate communication between hospitalized patients and their loved ones when physical visits are unable to be facilitated. Virtual visitation is distinct from telemedicine because the former is a video call is between patient and their family or friends, which may or may not include any healthcare personnel. Virtual visitation became widely adopted in 2020 because of visitation restrictions due to the COVID-19 pandemic.
Contents
Overview
Virtual visitation usually occurs between a patient who is admitted to a healthcare facility and their friends or family who are unable to visit the healthcare facility in person. The visit can be for emotional and social support[1], or to facilitate medical decision making with, or on behalf of, the patient. In some cases, more than two parties can be on the call using video conferencing technology. The involvement of the healthcare team in such calls may also be called telerounding (occurring during daily rounds, for example) or virtual family meeting (occurring with the patient and healthcare team at a time separate from daily rounds). Prior to the COVID-19 pandemic, there was limited evidence regarding the use of video calls to reduce social isolation and loneliness.[2]
During the COVID-19 pandemic, most hospitals and other healthcare facilities (such as nursing homes and assisted living facilities) restricted visitation from family and friends in order to limit transmission of the SARS-CoV-2 virus. Such restrictions prompted many facilities to implement virtual visitation to provide meaningful communication between patients and their loved ones. Although concern over privacy and security issues still exist[3], the flexibilities on HIPAA during the COVID-19 public health emergency[4] has eased concerns over the use of video-calling technologies.
Technology
Virtual visitation requires technology to facilitate the visit. Both the patient (or healthcare facility where the patient is admitted) and the family or friends need to have the hardware, software, and adequate bandwidth for a successful visit to occur. Additionally, the ability to operate and troubleshoot the hardware and software on both ends of the call is required.[5]
Hardware
Frequently, patients have their own smartphone, tablet, or laptop computer with them at the healthcare facility. However, when hardware is unavailable or the patient is unable to operate the hardware (for example, due to severity of illness), then some healthcare facilities are able to provide hardware, often in the form of a tablet, for the patient to use. If tablets must be shared among patients, then appropriate device cases and standardized protocols for cleaning the device between uses must be developed.[6] Other types of hardware include computers or workstations on wheels which can be brought into the patient's room on demand[7], or the use of existing monitoring technology such as virtual intensive care unit[8]. The devices may be able to be repurposed from other uses, otherwise they must be purchased by the facility or donated to the facility.[9] Occasionally when none of these options are available, members of the healthcare team have offered the use of their own personal device.[10] The patient’s family and friends must have access to and be able to operate their own device.
Software
A number of readily available video calling apps have been utilized for virtual visitation, including Skype, WhatsApp, FaceTime, Zoom, and Google Hangouts. The specific app that is used should take into consideration the type of device (e.g. FaceTime is only available for Apple products) that is available to all parties. Video conferencing capabilities may allow for more family members to join the visitation simultaneously, provide interpreter support, and allow for virtual family meetings.[11]There have also been privacy and security concerns with regard to some of the video calling apps.
Asynchronous videoconferencing technology has also been used to video-record rounding for families to review at another time.[12]
Bandwidth
Both parties must have adequate bandwidth to support the video call, which includes both download and upload speeds. If videoconferencing (i.e. more than two parties) is desired, then more bandwidth may also be needed. In situations where there is heavy simultaneous use of videoconferencing, for example during the COVID-19 pandemic, then the bandwidth must be even greater to support all of the calls. There must be attention to latency times whether due to connection limits or device limitations.[13]
Personnel
Even with the availability of the above technologies, the availability of personnel to assist with the use of the technology can be a limitation in the utility of virtual visitation. There must be at least one person on each end of the video call or video conference who is able to operate the device and make the connection to the call, and also be able to troubleshoot if there are any problems which occur with starting the call or during the call. Due to infection control concerns and limited personal protective equipment (PPE) supplies, there may be limited ability for nurses or other caregivers to enter patient rooms to assist with virtual visitation. Additionally, having a nurse assist with video visitation and troubleshooting prevents that nurse from caring for their other patients.[14] However, some hospitals have addressed this need by redeploying healthcare workers from other settings.[12][15]
In addition to availability of personnel, training of personnel is required to not only be technically facile, but also develop good communication skills specific to video-calling. Such skills are particularly applicable for telemedicine, but equally important for telerounding and virtual family meetings, and are helpful to setting up virtual visitation between patient and loved ones.[11][16] Patients and families should also be informed about the limitations of the technology.[14]
Healthcare settings
Virtual visitation has been implemented in different healthcare settings and for different purposes, including by palliative care teams, neonatal intensive care, and other intensive care units.[11] Some examples of adaptations for specific needs are described in this section.
Pediatrics
Some authors suggest that telerounding may have benefits for the pediatric population, particularly if it limits the number of healthcare providers in the room to those the patient has most comfort around, as patients can be uncomfortable advocating for themselves in front of healthcare personnel they do not know very well.[7]
Neonatal intensive care
Families who are able to use virtual visitation to see their newborns in the neonatal intensive care unit (NICU) have expressed appreciation of being able to see their infant, felt that visualizing their infant reduced their own stress and anxiety, and provided reassurance that their infant was doing well. However a minority of patients also felt guilt that they were unable to be with their infant when they viewed them on camera. Overall video visitation was found to be helpful and meaningful.[17]
Intensive care units
Some have suggested the development of a checklist (similar to other checklists used in the intensive care unit) to ensure high quality video calling takes place, including recommendations for the set up of the technology and the call, and attention to setting. For example, the visual impact of the patient in the intensive care setting who may be in prone position, with many lines and tubes, etc.[13]
Palliative care and hospice
Long-term care facilities
Patients and residents of long-term care facilities, such as skilled nursing facilities and assisted living facilities, rely heavily on visitation from loved ones for both social interaction, advocacy, and assistance with care. This is especially true of patients with dementia. Video visitation can be used to facilitate daily visitation, however this necessitates more staff time, possible wifi upgrades or acquisition of technology (for example, adaptive communications technologies). Although skilled nursing facilities are able to use Centers for Medicare and Medicaid Services (CMS) funding to implement such services, assisted living facilities do not have access to such funding.[18]
In a cross sectional survey of 161 participants who have loved ones residing in long-term care facilities, virtual visitation had no effect on participant or patient positive or negative emotions. The authors hypothesized that unfamiliarity of the technology (particularly for the elderly) may be contributing to lack of a positive effect, as compared with familiar technology such as the telephone.[19]
Reception
In one study of patients in an intensive care unit, family members virtually visited through video-calling. Surveys of the family members revealed universal appreciation of the information, courtesy, and initiative taken by the healthcare team, and felt that having regular contact with both the patient and healthcare team alleviated the suffering of both the patient and the family. However, families wished for increased frequency of contact, and other means of updates.[20] In another study, family members were interviewed after using WhatsApp video calling during clinical rounds (telerounding) at a palliative care and hospice center. Family members expressed that they were happy to attend rounds via WhatsApp, happy with the information gained, and they thought their loved one (patient) was happy to see them. However, they did not feel that the technology substituted their presence.[10] Others have reported that virtual visitations were meaningful for patients and families, and helped patients increase compliance with the healthcare team. Some have recommended that virtual visitation start as soon as possible during the hospital course, due to the possibility of rapid decline in clinical status.[14] In one case report, a survey to the surviving wife and son of a patient who died of COVID-19 revealed that the intervention of a video visitation to allow the family to say 'goodbye' to the patient gave the family some relief.[21] Additionally, a benefit of the video visitation is the potential to reduce psychological distress among clinicians.[9]
Some of the limitations of video technology include delays (e.g. latency), technical difficulties, limitations of scheduling, lack of eye contact, limited nonverbal cues, and lack of physical touch[8]. Virtual reality platforms may be able to bridge some of these shortcomings.[22] Criticism of the use of virtual visitation primarily centers on its use as a substitute for in person visitation, as an argument against the visitation restrictions at healthcare facilities. Existing disparities may further be exacerbated as underserved communities are likely to have less access to technology, and digital communication may not be conducive to different communication styles.[23][24]Setting up an iPad to prevent patients from dying alone is not a solution.
[25]
See also
Telemedicine – video calling technology used to conduct a healthcare encounter between a patient and a healthcare provider.
References
- ↑ Abel J, Taubert M. Coronavirus pandemic: compassionate communities and information technology. BMJ Support Palliat Care. 2020.
- ↑ Noone C, McSharry J, Smalle M, Burns A, Dwan K, Devane D, et al. Video calls for reducing social isolation and loneliness in older people: a rapid review. Cochrane Database Syst Rev. 2020;5:CD013632.
- ↑ Wakam GK, Montgomery JR, Biesterveld BE, Brown CS. Not Dying Alone — Modern Compassionate Care in the Covid-19 Pandemic. New England Journal of Medicine. 2020;382(24).
- ↑ HIPAAA and COVID-19 | HHS.gov - accessed October 20, 2020
- ↑ Using Skype during Pandemic Isolation - BMJ Supportive & Palliative Care - accessed October 17, 2020
- ↑ Ritchey KC, Foy A, Mcardel E, Gruenewald DA. Reinventing Palliative Care Delivery in the Era of COVID-19: How Telemedicine Can Support End of Life Care. American Journal of Hospice and Palliative Medicine®. 2020;37(11):992-7.
- ↑ 7.0 7.1 Rosenbluth G, Good BP, Litterer KP, Markle P, Baird JD, Khan A, et al. Communicating Effectively With Hospitalized Patients and Families During the COVID-19 Pandemic. J Hosp Med. 2020;15(7):440-2.
- ↑ 8.0 8.1 Sasangohar F, Dhala A, Zheng F, Ahmadi N, Kash B, Masud F. Use of telecritical care for family visitation to ICU during the COVID-19 pandemic: an interview study and sentiment analysis. BMJ Qual Saf. 2020.
- ↑ 9.0 9.1 Salway RJ, Silvestri D, Wei EK, Bouton M. Using Information Technology To Improve COVID-19 Care At New York City Health + Hospitals. Health Affairs. 2020;39(9):1601-4.
- ↑ 10.0 10.1 Mercadante S, Adile C, Ferrera P, Giuliana F, Terruso L, Piccione T. Palliative Care in the Time of COVID-19. J Pain Symptom Manage. 2020;60(2):e79-e80.
- ↑ 11.0 11.1 11.2 Lin CT, Bookman K, Sieja A, Markley K, Altman RL, Sippel J, et al. Clinical Informatics Accelerates Health System Adaptation to the COVID-19 Pandemic: Examples from Colorado. J Am Med Inform Assoc. 2020.
- ↑ 12.0 12.1 Billingsley L. Using Video Conferencing Applications to Share the Death Experience During the COVID-19 Pandemic. J Radiol Nurs. 2020.
- ↑ 13.0 13.1 Negro A, Mucci M, Beccaria P, Borghi G, Capocasa T, Cardinali M, et al. Introducing the Video call to facilitate the communication between health care providers and families of patients in the intensive care unit during COVID-19 pandemia. Intensive Crit Care Nurs. 2020;60:102893.
- ↑ 14.0 14.1 14.2 Goulabchand R, Boclé H, Vignet R, Sotto A, Loubet P. Digital tablets to improve quality of life of COVID-19 older inpatients during lockdown. Eur Geriatr Med. 2020;11(4):705-6.
- ↑ MetroHealth's Compassionate Care Rounders (video) - accessed October 17, 2020
- ↑ Chua IS, Jackson V, Kamdar M. Webside Manner during the COVID-19 Pandemic: Maintaining Human Connection during Virtual Visits. J Palliat Med. 2020.
- ↑ Murray PD, Swanson JR. Visitation restrictions: is it right and how do we support families in the NICU during COVID-19? J Perinatol. 2020;40(10):1576-81.
- ↑ Dobbs D, Peterson L, Hyer K. The Unique Challenges Faced by Assisted Living Communities to Meet Federal Guidelines for COVID-19. J Aging Soc Policy. 2020;32(4-5):334-42.
- ↑ Monin JK, Ali T, Syed S, Piechota A, Lepore M, Mourgues C, et al. Family Communication in Long-Term Care During a Pandemic: Lessons for Enhancing Emotional Experiences. Am J Geriatr Psychiatry. 2020.
- ↑ Carlucci M, Carpagnano LF, Dalfino L, Grasso S, Migliore G. Stand by me 2.0. Visits by family members at Covid-19 time. Acta Biomed. 2020;91(2):71-4.
- ↑ Galazzi A, Brioni M, Mistraletti G, Roselli P, Abbruzzese C. End of life in the time of CoViD-19: the last farewell by video call. Minerva Anestesiol. 2020.
- ↑ Riva G, Mantovani F, Wiederhold BK. Positive Technology and COVID-19. Cyberpsychol Behav Soc Netw. 2020;23(9):581-7.
- ↑ Valley TS, Schutz A, Nagle MT, Miles LJ, Lipman K, Ketcham SW, et al. Changes to Visitation Policies and Communication Practices in Michigan ICUs during the COVID-19 Pandemic. Am J Respir Crit Care Med. 2020;202(6):883-5.
- ↑ Sher T, Stamper GC, Lundy LB. COVID-19 and Vulnerable Population With Communication Disorders. Mayo Clin Proc. 2020;95(9):1845-7.
- ↑ Andrist E, Clarke RG, Harding M. Paved With Good Intentions: Hospital Visitation Restrictions in the Age of Coronavirus Disease 2019. Pediatr Crit Care Med. 2020;21(10):e924-e6.
External links
Kaweah Delta Virtual Visitations - example of virtual visitation implemented at one hospital.
Submitted by Da Jin --Dpjin (talk) 21:59, 20 October 2020 (UTC)
