Evaluation of a Commercial Communication Technology to Support ICU Procedures and Isolated Care during COVID-19
TimeTuesday, April 133:50pm - 4:10pm EDT
DescriptionWe present a case study investigating the use of a hands-free communication system to support isolated patients and procedures in the Intensive Care Unit (ICU) during the SARS-CoV-2 pandemic (COVID-19). We outline the impetus for this project, processes used in evaluation, lessons from performing the evaluation remotely, and the findings of the trial with respect to usability and communication.
The benefits of a clear, efficient communication system in the ICU to ensure patient safety are well understood (Curtis et al. 2006, Donchin et al. 1995, Jain et al. 2006), but the spread of a pandemic presents additional challenges that may render existing systems inadequate. First, the number of critically-ill patients stretches the availability of beds and staff and stresses the physical resources within the hospital (Barrett et al. 2020; World Health Organisation, 2020). Staff treating or attending to COVID-19 patients or suspected COVID-19 patients are commonly located in restricted access areas termed ‘red’ or ‘hot’ zones and are often required to communicate with staff who have no contact with these patients (located in ‘green zones’). These staff members may be in an adjacent room or more remote and not in visual contact. They must also wear personal protective equipment (PPE) that muffles verbal communication and obscures non-verbal communication. These physical barriers in themselves pose a challenge to normal methods of face-to-face communication. By minimizing the unnecessary donning and doffing of PPE, the limited resource of the PPE is preserved and there are fewer chances of self-contamination. Finally, clinicians working within a ‘red zone’ must limit contact with their face, mouth or shared items (such as a telephone handset), and should work efficiently to reduce the length of exposure to an infected patient, hence reducing the chance of contracting the virus (Sommerstein et al. 2020; World Health Organisation, 2020). Providing a hands-free communication solution would seem ideal in overcoming these restrictions.
The project was initiated in July 2020 as a second wave of COVID-19 spread through the community in Melbourne, Australia. The ICU at Alfred Hospital in Melbourne has spent more hours caring for COVID patients than any other in Australia, as of 16th December 2020. Thus, the ICU faced great safety communication difficulties, and urgently sought a fit for purpose digital solution to communication issues in the unit during COVID-19, with a focus on care for isolated patients and procedures. The ICU nursing leadership team consulted with Vocera Communications about their hands-free voice communication system, the Vocera Badge, and the accompanying software and support. The Vocera Badge is a small, wearable device which features a speaker, several microphones and an LCD screen (Vocera Communications, 2020). The ICU engaged with our group of digital health and human factors specialists to advise on and evaluate the Vocera Badge as an adjunct to the existing communication systems.
Due to uncertainty surrounding the epidemiology of COVID-19 in Melbourne, we planned the evaluation so that all steps could be performed remotely (in contrast to other studies of the Vocera system, e.g. Ernst, Weiss & Reitsema, 2013; Jacques et al. 2006; Tang & Carpendale, 2009; West, Lustik & Hopkins, 2019) and in consultation with the ICU and IT teams. The key components of the evaluation are: a cognitive task analysis (determining the cognitive and communication issues in the ICU during COVID-19, and how they may interact with the Vocera system); a pluralistic cognitive walkthrough (probing the usability characteristics of the system as end-users interact with it); surveys, including the System Usability Scale (SUS, used to evaluate usability); and simulations using the Vocera Badge for procedural support. Central to all these activities was clear communication with the ICU and IT, agility in our planning, and the capacity to optimise the resources available.
Early findings indicate that the system is effective for use by clinicians wearing PPE with isolated patients where hands-free communications is an imperative to minimize infection. However, procedure simulations suggest the system offers no advantages in its current state compared to other systems such as traditional handset telephony. The positive findings from observing the care of patients in isolation have important implications for teamwork within the ICU, quality of clinical care, provision of PPE and safety during COVID-19 and beyond. Usage and feedback from staff were mixed over the early stages of the trial, leading to adjustments from the ICU team. Our early findings suggest the system may be a useful adjunct, but not a replacement for, current telephony and paging systems.
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