When COVID-19 infections surged in Cleveland, University Hospitals Health System faced a difficult and emotionally touchy dilemma: Family members had to be barred from patient rooms to decrease the risks of spreading the virus. Even patients who were critically ill or dying weren't able to spend time with their loved ones.
This presented a couple of problems. The first and most obvious is that patients were unable to avail themselves of the support of family members, which created a sense of isolation on both sides that only made a difficult scenario worse.
That was just the start of it, though. The health system's philosophy is that the presence of family, caregivers and friends at a patient's bedside actively contributes to the recovery process. Add to that the inability of doctors and nurses to spend much time at bedside due to infection risks, and these factors added to a potentially fraught situation.
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"More than ever we realized we relied on families and caregivers for care of the patient even while they were in the hospital," said Dr. Joan Zoltanski, chief experience officer for University Hospital Health System. "We do our best to care for them like we always have, but we quickly learned we needed to place in a family caregiver during the pandemic. They help us understand the history of the patient, their current status with medications and all of that, and it also eases anxiety immensely while patients are in the hospital."
Luckily, technology has come to the rescue. The federal government relaxed some tech guidelines that allowed UHealth to use different types of technology, but perhaps as importantly, the system realized it could repurpose some of its existing technology to keep family members and caregivers in the loop.
Responding quickly to the public health emergency, Zoltanski and staff sourced iPads and other communication-equipped devices to patients, allowing the patient to connect both to family members and their doctors in a distanced, yet intimate way.
"We used technology in a unique way to make sure that caregivers and families get the same cadence of medical information that they would normally get during the course of a regular visit," said Zoltanski. "Partly this has been for the emotional aspect, but partly to make sure we're keeping patients as safe as we can."
SUPPORTING FAMILIES AND CLINICIANS
The iPads are among the HIPAA-compliant platforms that the government has authorized for use during the pandemic. While UHealth has to be as adherent as always regarding the handling of patient information, the allowable platforms themselves have been loosened. The health system has also implemented Vocera technology to help connect families to the bedside. That has proved critically important, since family members often have the most up-to-date medical information, particularly as it pertains to drug dosages.
The benefits to patients are immeasurable, but the benefit to hospital staff has been significant as well.
Take the sharing of medical information, for example. Twenty years ago, a night nurse who was caring for a patient would hand off her duties to the day nurse at around 7 a.m. The former would do a shift report and inform the day nurse of the night's events so they were both on the same page. Flash forward to 2020, and UHealth has moved that conversation to the patient's bedside, often with a family member or caregiver present. They talk about medical care as a group, and oftentimes the family member will clarify something about the patient that aids in their care.
"When COVID came and we couldn't have visitors, we worried about gaps in safety," said Zoltanski. "Instead of stopping the practice, we said we needed to continue this practice, because we know it promotes safety. Everyone gets on the same page. We know these practices are important for patients, to have people feel engaged and relieve that anxiety, and to provide support and safety."
Another added benefit for the health system itself is the decreased use of personal protective equipment, which has generally been in short supply around the U.S. and has proven critical in preventing the spread of infection among hospital staff. Since the technology employed by UHealth allows clinicians and family to touch base with the patient remotely, that has decreased exposure and reduced the rate at which staff goes through N95 masks, for example.
In that way, the remote technology is supporting broader physical distancing guidelines that limit the spread of the coronavirus – all without interrupting the care and safety of the patients. Best of all is that it supports processes that are already in place, so the adjustment has been primarily technological, as opposed to philosophical.
Zoltanski said UHealth will continue these practices after the pandemic ends, in part to give family and caregivers more options, especially when they have to balance work and other commitments.
"That's why the financial investment makes sense," she said. "These are practices that need to continue after COVID, when we do have visitors. These are devices and processes that can support safety. When the visitors have other lives, when they're out there working or taking care of their children, they can still be connected and not have to stay in the hospital all day. I'm hoping it continues in most places after COVID as well."