Virtual visiting, in some form, is here to stay

Dr Lara Mitchell is a Consultant Geriatrician at Queen Elizabeth University Hospital (QEUH), Glasgow. She is clinical lead for acute and has developed a frailty service. She is Chair of the BGS Cardiovascular SIG and tweets @laramitchdr. Dr Kaitlyn Mayne is a CMT at QEUH.

Prior to the COVID-19 pandemic, visitors were a huge part of ward life in Medicine for the Elderly. For our frail, older patients, this contact with their loved ones was crucial – when we ask patients ‘what matters to you?’- it’s almost always their family.

From healthcare workers’ perspective, visiting relatives played a pivotal role in patient care as they were able to feed back to us that their loved one was almost back to their usual self both in terms of cognition and mobility, aiding with discharge planning. We would know the visiting relatives and would be able give them updates as well as share stories of their loved one. When we had to break bad news, we would be able to do this face-to-face, while offering warmth and empathy along with tissues and cups of tea.

With the move to essential visiting only, we have had to adapt and consider how we can deliver the same care and compassion. Locally, we were acutely aware that we needed to move to a digital method, so our eHealth department delivered an iPad to each Medicine for the Elderly ward in GGC South Sector - and our adaptation began.

Each ward faced the preparation phase, considering how were they going to deliver this, how to use the apps, and how to book relatives in. With time, teams have developed ways of making it work, with some using daily appointments, and other using a weekly diary to keep track of contacts.  All staff have embraced the technology and successfully navigated videoconferencing tools such as Zoom, Facetime and Skype. I suspect that many have been motivated by the impact of these interactions on patients and relatives. It has been compassionate and heart-warming, and this drives us to deliver more! Understanding the concept of seeing a loved one on a screen can be tricky for some patients, many of whom do not own a smart phone. However, the impact is overwhelmingly positive as we see faces light up with smiles and laughter which keep staff going through this period of change.

Across Medicine for the Elderly, we have used the technology in a variety of ways. Firstly, we have used it purely as a communication device between patient and relative so they can keep in touch, which has helped with physical distance from their loved ones. Secondly, it has helped us overcome remoteness - we have contacted families all around the world in order to connect between London, France and Australia and more.  We’ve also been able to connect multiple family members at the same time, when this wouldn’t always be possible with standard visiting.

It has also been helpful in gauging cognitive and physical function and assessing the patient’s progress with rehabilitation. Our allied healthcare professional staff have held joint sessions with relatives via the iPad in order to facilitate discharge. They have noticed that patients are increasingly motivated to progress when their families are connected digitally to a session.

We have even celebrated birthdays using digital technology. Yesterday, one ward connected a patient with his daughter via Facetime, with all the staff singing a (socially distanced) happy birthday whilst the patient enjoyed his favourite whiskey with level 1 thickener, showing patient-centred care at its very best. Another ward used Zoom to connect a number of relatives in different geographical locations to wish a patient a happy 93rd birthday with all of her family. We should continue to consider these new successful techniques when our normal visiting resumes.

Virtual communication is not always easy however, and can be unsettling for both patients and families. At times, staff need to comfort patients who can become distressed by seeing their loved ones. It can also be very upsetting for relatives, seeing their loved one unwell yet physically far away. On another ward, a colleague had been using Facetime every day to connect with the family of a patient who was unwell and poorly responsive. This had been distressing for the family until one day there was a breakthrough and she managed to wave at her daughter via the iPad. The sense of joy and comfort that this gave the family was immeasurable and it was deeply touching for the nurses to witness.

I suspect virtual visiting is here to stay and we need to engage with it, to ensure we continue to deliver compassionate care. It is emotional for patients, relatives and staff but can be incredibly rewarding and fun at the same time. It can be a good solution when families are geographically distant or unable to visit for other reasons and therefore may be an example of positive innovation arising from the current pandemic.