key: cord-0862314-klcqwdqw authors: Negro, Alessandra; Mucci, Milena; Beccaria, Paolo; Borghi, Giovanni; Capocasa, Tania; Cardinali, Matteo; Pasculli, Nicola; Ranzani, Roberta; Villa, Giulia; Zangrillo, Alberto title: Introducing the Videocall to facilitate the communication between health care providers and families of patients in the intensive care unit during COVID-19 pandemia date: 2020-05-26 journal: Intensive Crit Care Nurs DOI: 10.1016/j.iccn.2020.102893 sha: 7434eb6a4851013c31c054c969d9c150ae03d5b8 doc_id: 862314 cord_uid: klcqwdqw nan Communication between health care providers, patients and families has been identified as the most important and least accomplished factor in quality of care in the intensive care unit (ICU) (Kleinpell, 2014) . Many studies have shown that communication with caregivers is one of the most highly valued aspects of care (Kentish-Barnes et al., 2018; Nelson et al., 2006; Long et al., 2014) . The receipt of honest, intelligible, and timely information is among the primary concerns of family members of patients in the ICU (Curtis et al., 2001; Wood et al., 2018) . In addition, they need support, comfort, proximity, and reassurance (Henrich et al., 2011; Wood et al., 2018) . Families want to feel that there is hope and they generally want to know the prognosis (Kon et al., 2016) . Effective communication improves family satisfaction, trust in ICU physicians, clinical decision-making, and the psychological well-being being of family members (Lilly et al., 2000; Wood et al., 2018) . Complete isolation due to the COVID-19 pandemic restrictions enables the cliniciansfamily meetings and the limitations of the hospital visitation policy do not permit to caregivers to be near their loved ones, with the risk of leaving them without any form of trusted representation and advocacy. Literature report that front-line clinicians in their organizations experience distress in patient and family conversation about wheter COVID-19 testing is appropriate and/or available, limitations on care delivery resources, difficult decision-making, families separated from sick or dying loved ones to prevent the spread of infection, and fear of a virus whose characteristics and long-term consequences are not yet known (Bowman et al., 2020) . On the basis that an extended family visitation policy in the ICU can be associated with reduced occurrence of delirium and shorter length of delirium/coma and ICU stay (Rosa et al., 2017) , we assumed that videocall could be a method to mitigate the bad effects of isolation. The aim of this brief report was to set up an intervention designed to improve communication quality and outcomes between providers and families of patients in the ICU. We started to use video calls between patients and families and also for the daily communication between clinicians and families. We developed a checklist to guide clinicians leading the video call between a patient and his/her family (Fig 1) . Checklist could be a support and guide for clinician during the call. It give support during conduction, uniform conversation and assure information. Before start the video call it is important to create the setting for the patient and for the team. Clinical and emotional patient's condition have to be stable, it is not recommended to start a videocall with patients with a RASS score > 2. The team should not be managing an emergency situation or an admission of a new patient. After setting preparation the video call can start following the check list. The tool help clinician to conduct the call. It is composed by some phases: preparation call with the family member, preparation of the patient, preparation of the caller, start, conduction, end. Preparation call with the family member  Name of the patient ___________________  Ask if family members want to get in touch with their relative by video call, allow them time to reflect on it and legitimize any response  If yes, anticipate that you will call them at the agreed time, advising them to wait for the call in a quiet place taking a sit.  Evaluate and settle the presence of children.  Inform that the video call will be short and should be based on positive and encouraging contents.  If the patient is unable to verbalize, for example because he/she has an endotracheal tube, ask the family members not to ask open questions Preparation of the patient  Ask the patient if they want to get in touch with someone on video call and with whom, leave time to reflect on it, without influencing, and legitimizing any response.  If yes, prepare him or her by optimizing the position  Inform that the video call will be short Preparation of the caller  Make sure to call at a suitable time for you and for the team  If appropriate, involve other professionals in the call  Call the family member at the scheduled time!  Inform the whole team that you are about to make a video call, in order to set up an adequate environment and limit the interruptions.  Check for the calling devices and web connection.  The video call begins outside the patient's vision  Present yourself with name and qualification.  Check who you are talking to.  Smile and approach the patient talking to the family member  Connect the patient and the family member Conduction  Stay close to the patient and check his/her reactions  If necessary, help to understand the contents  If the patient presents fatigue, disinterest or other unfavorable condition, bring the communication towards closure. End  Take back control of the communication, thank the patient and move away from him/her telling that you will come back  Check the emotional state of the family members and allow them to ask for questions.  Take a few minutes for yourself. Fig 1. Checklist for the video call in ICU between the patients and the relatives Addressing barriers to facilitate better communication in the ICU is a priority area to enhance patient safety as well as promote optimal interaction and patient satisfaction. The videocall is often carried out some days or, more frequently, weeks from the last time the families met their loved ones. During this period patients have often been treated in prone position for long times, have an orotracheal tube, a nasogastric tube for enteral feeding and other devices that contribute to change the image of a person. Families can be worried about the patient, we need to prepare them. The caller should spend time in introducing the current situation of the patient thinking not only about the clinical state, but also the visual impact. In a period in which families can only hear by phone a voice often telling them bad news, the opportunity of "meeting" the clinicians caring for their loved ones appear to be a chance to give something more. Physicians and nurses in ICU are not used to communicate in this way, but our team reveals adaptability and creative characteristics. We use tablet or phone calls and the advices for the preparation are the same as the videocall between patients and family. The conduction flows as a normal ICU family meeting, keeping in mind to respect the augmented dialogue times, due to possible devices and connection limits. Lessons learned: Always be open minded to new ways of acting your mission. 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Effectiveness and safety of an extended ICU visitation model for delirium prevention: a before and after study Communication in the ICU: Holding a family meeting Acknowledgments: The authors would like to thank all the health care staff of the COVID-19 ICU 2, who participated in the emergency, for their invaluable contribution.