For patients in intensive care units (ICUs), communication can be a real challenge. Despite being fully conscious, many are intubated and incapable of speech, meaning they struggle to express their needs. As studies have shown, they tend to rely on head nods, gestures, mouthing words and, less commonly, writing. However, some patients are too weak for this to be an option.
At best, this is extremely frustrating for the patients, their caregivers and families. At worst, it can be a real source of distress and can contribute to the development of ongoing mental health problems. More than a fifth of those who have survived intensive care suffer from post-traumatic stress disorder (PTSD), while 30% are left with anxiety and 40% with depression.
Assistive communication tools for ICU patients do exist, ranging from the low tech (eye gaze boards, alphabet boards etc) to high-tech, specialised devices. According to one 2015 study, around half of all patients on ventilators could be helped by these kinds of tools. However, patient communication devices are not consistently available in ICUs, for reasons that researchers are just starting to explore.
myICUvoice: hearing patients’ side of the story
In the midst of the Covid-19 pandemic, one UK hospital took matters into its own hands, rolling out an app called myICUvoice. The app, designed by an ICU doctor and trialled at Addenbrookes Hospital in Cambridge, uses touchscreen technology on an iPad to facilitate communication with patients.
“If you are in intensive care and you can’t explain or communicate even your most basic symptoms, thoughts or needs, imagine how horrific, distressing and frustrating that must be,” said Dr Tim Baker, who developed the app. “I wanted patients to be able to communicate about how they are doing and feeling, and hear their side of the story.”
The app enables patients to express symptoms and needs that ICU staff would otherwise miss. In a video for BBC News, patient Carole Guilliano describes it as a ‘godsend’. Unable to talk after a 12-hour operation, she taps on various icons to explain her mood, the location of her pain and the quality of her breathing. She also uses a type-to-speak function to chat to hospital staff.
Doctors and nurses have benefited too. Dr Mark Jeffreys, who used the app with Covid-19 patients, said: “One of our patients used myICUvoice to ask about her son. It was only then that we realised she had become convinced he had died – and we were able to get him on a video call later that day to reassure her.”
The app was designed using a £40,000 development grant from the Addenbrooke’s Charitable Trust. In addition to the patient communication tools, it features a Nurse Zone that nurses can use to log symptoms. Over time, the patient data will be analysed at a population level to build a better understanding of these symptoms, and allow nurses to pre-emptively treat them.
A free app available on the App Store, myICUvoice is now being translated into 12 languages and is being adapted for other indications.
EyeControl: remote communication in a pandemic
In August, Israeli company EyeControl announced it had secured over $10m in funding, after closing a Series A round and winning the Enhanced European Innovation Council (EIC)’s Covid-19 Pilot Programme. The company provides assistive communication devices for ‘locked in’ patients and – pertinently during Covid-19 – those in intensive care.
The device is wearable, screenless and lightweight. It uses a heat-mounted infrared camera to track the patient’s eye movements, before translating those movements into audio communication. Importantly, patients find it easy to use and operate – in a user trial, the average training duration was only 20 minutes.
It has proven particularly useful during the pandemic in that it enables remote communication without any risk of contagion. Ventilated patients can communicate with medical staff and loved ones from outside isolated units. The company has been trialing the device on Covid-19 patients and, following its new financing, plans to expand its reach.
“I am very excited and proud to take part in EyeControl’s mission to improve communication for ventilated patients,” said Avner Halperin, chairman of the board of directors. “Management has led the company to great achievements, including the recent EIC win. The EIC recognises that EyeControl is solving a critical issue with tremendous global impact. This funding will assist the company in accelerating growth and strategic partnerships worldwide.”
EASE : easing families’ minds
Another technology improving the healthcare experience, albeit in a different way, is an app called EASE. Designed by a Florida-based company of the same name, which was recently acquired by Vocera Communications, the app enables friends and family members to receive updates about their hospitalised loved ones.
First, the patient adds friends and family members to their distribution list. Then, with a simple tap, the doctor or nurse can send texts, photos and videos relating to the patient’s progress. More than 1.6 million messages have been sent since the app was first rolled out, and surveys have been clear about the benefits. In one survey of 8,000 families, 99% of family members ‘strongly agreed’ that EASE reduced their anxiety, and 93% ‘said the availability of EASE would influence their choice of hospital.
“Now, more than ever, meaningful human connections are needed in healthcare,” said Patrick de la Roza, chief executive officer of EASE. “When a person undergoes surgery or is hospitalised for an infection or other illness, the patient and their loved ones often feel fear, anxiety and isolation. EASE helps reduce these burdens by providing needed connectivity and transparency, while allowing care teams to deliver the best care.”
Importantly, the app is secure and HIPAA compliant (HIPAA being the American legislation that keeps patients’ medical information safe). Updates vanish 60 seconds after being viewed, and nothing is saved on the recipient’s mobile device. Unsurprisingly, it has earned the moniker ‘Snapchat for the operating room’.
Vocera Communications, which announced it had acquired EASE in August, said it was “excited to add this innovative, patient-facing solution to our portfolio”. The company already provides a range of communication solutions for care teams, allowing hospital staff to securely text or call each other, but EASE is different in that it involves the patient’s family directly.
Why this tech is so vital
Clearly, the Covid-19 pandemic has forced the need for healthcare communication technologies of this kind. With an unprecedented number of patients in intensive care, and face-to-face visits often not possible, there has been a sizeable demand for creative solutions.
We might add that, since Covid-19 is a new disease with often mystifying symptoms, healthcare providers can’t rely on assumptions about how a patient might be feeling. They need ways to talk to them directly.
According to one ICU patient who used myICUvoice while intubated: “It gave me and my family an opportunity to share emotions as well as medical knowledge, and this undoubtedly had an immeasurably positive impact on my recovery out of the critical life-threatening situation I was in.”