key: cord-0892301-wy7clgyl
authors: Galazzi, Alessandro; Binda, Filippo; Gambazza, Simone; Lusignani, Maura; Grasselli, Giacomo; Laquintana, Dario
title: Video calls at end of life are feasible but not enough: A 1‐year intensive care unit experience during the coronavirus disease‐19 pandemic
date: 2021-05-05
journal: Nurs Crit Care
DOI: 10.1111/nicc.12647
sha: 72afb098625bf2a0e6a5ebd2709e32cdefa5ca39
doc_id: 892301
cord_uid: wy7clgyl

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The coronavirus disease (COVID-19) pandemic has turned our lives upside down and virtually all care settings have undergone profound transformations worldwide. In a short time, thousands of patients required hospital treatment, many of them in an intensive care unit (ICU). 1 One of the most critical aspects for patients, their families and health care professionals (HCPs) was the isolation, which was severe, especially at early stages of the pandemic. 2 The mortality associated with serious infection necessitated public health measures to restrict family visits to hospitals, in addition to the shortage of personal protective equipment. 3 Abruptly, the long process of opening ICUs to families 4,5 was terminated, generating an overall sense of loneliness that overwhelmed not only patients but also their families and HCPs. 6 Thousands of people died without their families being present. 7 However, patients did not die alone, nurses and physicians were there and cared them until their last breath. 8 As HCPs living in a technological era, where the digital medium is supposed to bring people together and used to help, several hospitals used video calls to bridge the gap between patients and their families.

The extensive use of this method of communication, subsequently recommended by the Italian Critical Care Scientific Societies and by the literature, 9, 10 has pushed our ICU team to use video calls, not only as a window to the external world on a daily basis, but also as a chance for caregivers, family members or friends of patients to say goodbye before the withdrawing life-sustaining treatments or imminent death. 11 In this commentary, we would like to share our experience using By the term EOL-video call we mean calls made via tablet or smartphone with a camera on, performed in a structured way, that is, after it was made clear to patient's family members that intensive treatments were going to be suspended to leave space only to palliative treatments or when the patient's death was imminent. The EOL-video call was always proposed by the consultant physician, who provided daily clinical information to the family members for the entire duration of the ICU stay.

If the family members consented, the video call was handled by the physician and the nurse in charge. The timing of the EOL-video call was agreed with the relatives, sometimes engaging chaplaincy support, if desired.

Before starting the video call, all the ICU staff were informed, and we attempted to reduce distractions in the ICU environment (alarms silenced, curtains drawn) and the patient was prepared to be seen by family members or relatives, considering that some of the procedures occurred during ICU stay may have changed their appearance. 12 During this period, 297 patients were admitted to ICUs, and 70 (23.6%) died. Only two patients were conscious at the time of ICU admission. The distribution of EOL-video calls over time is depicted in During each video call, both physicians and nurses remained at the bedside, trying to make family members as comfortable as they could, reassuring the relatives that the patient was comfortable and not in pain, which was the most recurrent concern expressed by relatives. Requests to caress the patient's face or hold their hands were welcomed as well.

The choice of using video calls peri mortem was much debated by the ICU team, because some physicians and nurses believed that this modality could be traumatic for family members and for the staff. As recently reported, some ICUs in the United Kingdom also deemed patients ineligible at end of life for video calls. 13 Indeed, several barriers are identified. Some families may feel that seeing their loved one in a different shape (looking gravely ill and with lines and tubes in situ), rather than a good memory they had before hospitalization, is not the best way for them to see the patient as their last memory. when restrictions or prohibition of family visiting were the biggest barrier to communication and to family-and patient-centred care. The COVID-19 pandemic has also revealed that a digital divide might have serious consequences on several aspects of our life, including the chance to say goodbye to loved ones. EOL care with family members at the bedside is, and must always be, the first choice.

Critical care utilization for the COVID-19 outbreak in Lombardy, Italy: early experience and forecast during an emergency response

COVID-19 in critical care units: rethinking the humanization of nursing care

Death and dying during the pandemic

Patient and family engagement in the ICU: report from the task force of the world Federation of Societies of intensive and critical care medicine

Validation and analysis of the European quality questionnaire in Italian language

Restricted family visiting in intensive care during COVID-19

Life in the pandemic: some reflections on nursing in the context of COVID-19

Clinician perspectives on caring for dying patients during the pandemic

How to communicate with families living in complete isolation

End-of-life care during the COVID-19 pandemic-what makes the difference? Nurs Crit Care

End of life in the time of COVID-19: the last farewell by video call

Introducing the video call to facilitate the communication between health care providers and families of patients in the intensive care unit during COVID-19 pandemic

Communication and virtual visiting for families of patients in intensive care during COVID-19: a UK National Survey

Symptoms of anxiety, depression, and peritraumatic dissociation in critical care clinicians managing patients with COVID-19 a cross-sectional study

The authors express their gratitude to all ICU nurses and physicians of Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, for their effort during the pandemic, showing professionalism that includes great