715 The development of a family liaison team to improve communication between ICU patients and their families during the COVID-19 pandemic

Abstract

<h3>Background</h3> High quality family centred care is an integral part of how sick patients are managed in modern healthcare systems, and remains imperative in times of crisis. However in the 2020 COVID-19 pandemic the necessity of isolation and social distancing prevented families accessing the support they usually would when a relative is on ICU, exacerbating the family’s worries and feelings of fear about their loved one. Additionally, in order to increase capacity 4 fold, ICU teams were not able to prioritise communication with families due to clinical pressures. <h3>Objectives</h3> Paediatricians with pre-existing transferable skills developed and embedded a communication strategy within ICU for the duration of the COVID-19 surge. The aim was for all families to be updated at least once daily and offered the option of using video links to speak to their relatives. <h3>Methods</h3> A proposal was agreed with the ICU matrons. With their approval a team of acute and community paediatricians was assembled. QI methodology was used and 4 PDSA cycles recorded. <h3>Results</h3> PDSA cycle 1: 3 paediatricians immersed themselves into 3 different clinical subsections of ICU. Ward rounds were attended following which families were phoned with updates. Difficulties for the team included a lack of understanding about a new disease, unfamiliarity in looking after adult patients. Communication with families whilst wearing full PPE was challenging. The team undertook a daily debrief. PDSA cycle 2: 4–5 paediatricians attended daily, in blocks of at least 3 days in a row, which allowed for continuity and comprehensive cover of the ICU patients. A proforma was designed to standardise what information was helpful to record on the ward round based on common recurring questions. PDSA cycle 3: A trial of a video-link virtual visit was conducted in 1 patient per clinical area. Patient feedback was recorded. PDSA cycle 4: The use of video links was expanded. Medical students were trained to facilitate video calls. Numbers of incoming family calls to ICU were monitored. Records were kept as part of a communication daily sheet within the ICU notes. <h3>Conclusions</h3> Paediatricians and other health professionals have transferable skills which enable them to work in ICU settings The project was successful due to a combination of clinical need, the feeling of ‘all being in it together’ and building joint resilience when faced with working in unfamiliar environments. Lasting collaborations between colleagues remain. Keeping the team small at the start of the project enabled us to develop profomas, anticipate components of successful phone calls and standardise them accordingly. Medical students were invaluable in setting up and facilitating video calls to families. They were able to schedule shift timings so that calls could be undertaken at a wider range of points in the day. As Covid subsides, the regular calls, video links and holistic thinking about families has been spotlighted within ICU and plans to maintain the service are being developed. It is possible to set up a Family Liaison Team in a short space of time, and would be replicable should a further COVID surge arise.