These are our healthcare heroes at work.
From ICU rounds at Poudre Valley Hospital, part of UCHealth: Starting from the left standing we have Respiratory Therapy, Palliative Care PA, and Chaplain. Sitting from the left are RN, intensivist MD and Charge RN. In front of the intensivist (in green scrubs) is a telephone on the desk. The telephone is on ‘speaker’ and dialed in to a conference line. Also dialed in are: Pharmacist working remotely, Nurse Communication Liaison working remotely, Social Work.
So many great things going on here: Social distancing as much as practical (too much further and you can’t hear each other over the din of electronic alerts across the ICU), N95 masks (all day every day), reviewing data together from so many disciplines, discussing each patient in detail and taking immediate actions (placing orders, creating consensus on medical decisions, dividing tasks for rapid action).
In times of pandemic, the hospital follows infection prevention protocol and isolates very sick, very infectious patients. In this case, we have grouped and isolated all Covid-19 patients into a distinct unit, away from non-COVID patients. And, we have universally disallowed family members to visit hospital patients at all.
This is both good medical practice, and heartbreaking to families who cannot be present at a patient’s most desperate hour.
Out of this swirl of confusion, Julie Griffin, Nurse Manager of Care Management, thought: we have highly qualified nurses on-leave at home (orthopedic unit nurses with no post-op surgical patients; pregnant nurses for whom COVID-19 infection would be particularly dangerous); how might they help share the burden of patient care with bedside nurses, and still minimize risk of contagion and exposure?
And so was born: Nurse Communication Liaison. Nurses from home, helping keep families connected, and reducing the burden on bedside nurses. We have nurses helping with med/surg units as well as ICUs, as described by ICU nurse Molly:
7 am: My day starts at 7. I review the Epic EHR chart from home for patients in the ICU. I read the overnight notes from the nurses and doctors in our 12-bed unit. By the way, our unit has moved to double occupancy; we’ve expanded to be a 23 bed unit. So much has changed. We’re so much busier.
8-10 am: I start receiving calls from family members and give any updates I can on their loved ones, based on what I know. I am using Epic secure chat (a HIPAA-compliant text message service) to communicate with the ICU bedside nurses, social workers, and respiratory therapists. I love secure chat because it means the bedside nurse — who is gowned and gloved — doesn’t have to scrub out to answer another phone call. They can catch up with chat-messages when there’s a break in the action.
10-11 am: Daily ICU rounds (picture above), where the team discusses every patient; I’m on the conference phone. It’s a complete team with everyone pitching in.
11 am – 4:30 pm: We have designated one main contact family member for each ICU patient. We’ve found it can be overwhelming to have many family members calling each day for updates. I am so happy to be able to serve as the main contact for these family members and unburden our extremely busy bedside nurses to focus on their patients.
Some great unexpected moments:
Jamie: “Bedside nurses often spend 15 minutes talking on the phone with families. Multiply that by five, and it becomes a big part of your day. We all wish we had more time to talk to families, but we’re often too busy caring for patients. I love helping connect with families and reassuring them.”
“One gentleman was not doing well. He was very quiet on the phone, and would never ask for anything. I spoke with his close friend at home, who noted that he was Jewish, and might appreciate a visit from a Rabbi or the Chaplain. I was able to arrange that.”
“Being an ortho nurse on a medical unit, I was anxious at first. But by communicating with bedside nurses through secure chat and occasionally the phone, I found that even if I couldn’t answer families’ questions, I could always find out. Families are always so appreciative of the extra communication. I love this role. It is really awesome.”
Dawn: “The difference with this role is: There’s only the person on the phone. It is quiet at my home on my end. Normally when I’m at the bedside, I’m always trying to ‘wrap up the conversation’ with family; there are so many other things needing my attention. I can really feel good about being focused, connecting with family, and freeing up bedside nurses to do their jobs.”
“I was on the phone with the husband of a Covid patient. I noticed he would occasionally grunt, while we were talking about his wife. I had to ask him: ‘Are you okay?’ He told me he had had a fall, and had to pull on his pant-legs to go up the stairs. I recognized the signs of a major injury. It took some convincing, but I finally got him to call his doctor. Turns out the next day he was admitted and had emergency surgery himself.”
[As an ortho nurse, she was probably the perfect person to help.]
Davida: “Sometimes you can remind the bedside nurse by secure chat: ‘his daughter would like to see his face today. Can you get the tablet in there for a Zoom visit?’”
“I feel really useful, being able to connect with PT, social work, and bedside nurse, all by non-interruptive but efficient secure chat, and then calling to make sure the family stays informed.”
Molly: “It is completely weird not to be an ICU bedside nurse right now. I think I will be better at charting in the future. Not being able to see the patient lets me understand what pieces of information families want to know that I rarely wrote down before: how do they look? Are they following commands? Can they squeeze? How scary this is for the family, and although it is a tricky role for us, it feels great to be helping.”
This piece was originally published on The Undiscovered Country, a blog written by CT Lin, MD, CMIO at University of Colorado Health and professor at University of Colorado School of Medicine. To follow him on Twitter, click here.