Background:  Patients who are admitted to a health care facility (e.g., hospital, free-standing hospice, nursing home) are at risk of being isolated from loved ones, especially if they are fatigued, physically incapacitated, geographically distant, amid a pandemic/crisis, and/or do not have a smartphone. While there is limited evidence to guide video call practices, this Fast Fact assimilates expert opinion and anecdotal experiences to offer tips and what to expect when clinicians utilize electronic devices for visual communication between patients, loved ones, and staff. See Fast Fact #406 for information on telemedicine communication and #76 and #77 for specific types of telephone encounters. 

Patient-Family Contact:  Patients in a care facility commonly feel disconnected from their loved ones, especially if there is a lack of technological resources to connect them. While this can have implications on the patient’s sense of wellbeing, clinicians often fail to recognize when patients are unable to call or speak to family or friends. Therefore, it is important for clinical staff to routinely ask patients if they are maintaining connection with loved ones while under facility care. For patients who are not able to accurately provide this history (e.g., history of memory impairment), clinicians should confer with the interdisciplinary team to ensure routine virtual visits are occurring if desired and feasible. Ideally, the care institution should have procedures in place to provide technical resources and educate/assist patients with making video calls. However, when patients need further assistance, clinicians should offer to assist in initiating a video call between the patient and family.

Patient Privacy and Consent: The best practice is for clinicians to use facility-provided rather than personal devices when assisting patients in initiating video calls with loved ones. If use of a personal device is unavoidable, either precede the call with *67 or utilize an encrypted software that masks the owner’s personal information (e.g., Doximity ®) to help maintain privacy (1).  If a patient is incapacitated, consent from the surrogate decision-maker and/or heath care institution may be necessary to minimize the risk of improper release of protected health information.  Check with your IT staff to inquire the best way to a secure network that protects two-way, real-time video communication. For this purpose, some hospitals have established devices or video call centers (2). 

Hardware and Software:  In general, utilizing the facility’s preferred platform and device is suggested.  In situations where this is not possible, enhance the visual experience by using a device with the largest screen possible. Additionally, wheeled stands for tablets provide image stability while allowing users to be hands-free. Most protective cases can be easily cleaned with an alcohol wipe between use to minimize infection risk (3). Widely available platforms (e.g., FaceTime, Google Duo) can bring family members together who use the same software.

Conducting the Video Call:  The following tips apply for patients who are unable to initiate a video or phone call with loved ones on their own:

• Prior to beginning the call, make sure the patient’s clinical condition is stable.  For example, you may want to delay the video call if the patient is uncomfortable, or their face is obscured by bandages. If possible, check with the patient before proceeding; if not possible, call the family and prepare them for what they might see (4).  
• Stage the room: ensure proper lighting and tidiness; cover the patient with a sheet if necessary; move infusion equipment and other machines out of the field of vision; minimize ambient noise by silencing monitors and alarms if appropriate so that the audial connection is maximized.
• Introduce yourself and your role in the patient’s care. Ask family members to do the same.
• Begin the video visit outside the room or with the patient outside the video frame. Then provide a warning shot informing the family of what they are going to see. Prepare loved ones by saying that they are in a [hospital/long-term care/hospice facility] setting. If the patient has an endotracheal tube and cannot speak, inform the family, and discourage open-ended questions. Loved ones may be shocked to see the patient in their current condition so allow time for emotional responses. 
• Monitor reactions in case the patient becomes fatigued or is desiring to bring the call to a close. 
• Give patients and families space and time to share intimate or private moments. Excuse yourself when necessary.

After the Video Call

• Requests to call other family members are common. Be transparent regarding your availability to carry through with this task to avoid over-promising.  Ask the patient and/or loved ones to identify a spokesperson who can inform other relevant persons who could not participate on the call. 
• Regular, scheduled video calls may relieve anxiety and mistrust. Keeping family informed and in contact with the patient may also reduce clinical surprises and help in the facilitation if goals of care discussions are necessary. 

References

1. Taylor, J. Is FaceTime HiPAA-Compliant? Published October 21, 2020. Available at https://simplevisit.com/is-facetime-hipaa-compliant/. 
2. Jain R. “India rolls out coronavirus call centres to stop stampede to hard-pressed hospitals.” https://www.reuters.com/article/uk-health-coronavirus-india-diagnosis/india-rolls-out-coronavirus-call-centres-to-stop-stampede-to-hard-pressed-hospitals-idUKKBN21E23U.
3. Using Skype during Pandemic Isolation. Available at https://blogs.bmj.com/spcare/2020/03/15/using-skype-during-pandemic-isolation/.
4.  Negro A, Mucci M, Beccaria P, et al. Introducing the Video call to facilitate the communication between health care providers and families of patients in the intensive care unit during COVID-19 pandemia.” Intensive Crit Care Nurs. 2020 Oct; 60: 102893. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7247985/.

Authors’ Affiliations: John H. Stroger, Jr. Hospital of Cook County. 

Conflicts of Interest:  None.

Version History:  first electronically published in June 2021; originally edited by Sean Marks MD