Patient Safety / Quality

Virtual visiting: The next best thing to being there

Virtual visiting brings the world to the patient’s bedside. Built-in computer cameras, text messaging, e-cards, social networking sites, and other high-tech methods allow hospital patients to stay connected to loved ones unable to visit in person. They connect patients with family and friends anywhere around the world, at any time, providing the next best thing to bedside visitors. Patients have driven this change by bringing connective technologies into hospital settings.

Today, most of us have relatives and friends who are dispersed around the country or even the world. Our lives are busier, we work longer hours, and urban sprawl has made traveling more complex. These realities can pose obstacles to hospital visits.

A virtual visiting program can help fill the gap when loved ones can’t visit in person. Here’s one example: Michelle spent several months in a critical care unit located 1,118 miles away from her family and friends. But using a webcam, she was able to stay connected and even celebrate special occasions with them.

Even for patients whose family lives relatively close to the hospital, the demands of daily life and restrictive hospital visiting policies can make regular visits difficult. Tran, a mother of three young children, was hospitalized for pulmonary hypertension. Because of her compromised immune system, she couldn’t have visitors. Fortunately, her brother was able to provide a computer, enabling virtual visits with her children and allowing her to remain a vital part of their daily lives.

Benefits of virtual visiting

A virtual visiting program enhances patients’ autonomy by allowing them to determine who can visit and when. Patients have reported that virtual visiting decreases their boredom, uplifts their spirits, and reduces feelings of loneliness or depression. Although no studies have been done to determine the effects of these programs on patient outcomes, conducting such a study is a future objective.

The medical/surgical intensive care unit of Toronto General Hospital in Toronto, Ontario, piloted a year-long virtual visiting program. In the program, 18 patients were able to have virtual visits with loved ones around the globe. Thanks to this project, patients throughout the hospital now have access to the virtual visiting program. The program has been successful for all involved. Its main effect has been to enhance the quality of life for patients and their families. It also produced these additional benefits:


    • Patients were weaned from ventilators for longer periods and had lower pain scores.
    • The computer keyboard gave patients who were unable to vocalize their thoughts because of a tracheostomy or endotracheal intubation a way to communicate with others.
    • Family members reported feeling more connected and less anxious when they heard from the patient directly.

 

  • Healthcare providers were able to reach out to the patient’s home and community. Seeing the patient’s home environment gave them insight into the patient’s psychosocial status.

 

Implementing a program

All it takes to implement virtual visiting is Internet access and a computer with appropriate software. If the computer doesn’t have a built-in camera, a webcam will be needed. To avoid confidentiality breaches, patients should use an Internet server separate from the hospital’s network.

Today’s software is designed for general public use and doesn’t require extensive knowledge. The user simply creates a personal account through an Internet provider (such as AOL, MSN, or Yahoo), then downloads appropriate software—for instance, MSN messenger, AOL, or Skype. The software allows the patient to interact with others and engage in online conversations. Support services are available to guide users through any problems.

Using a wireless router or Internet cable enables transmission and access to the World Wide Web. If these links aren’t available, a portable plug-in modem can be used; this modem functions on a principle similar to a cell phone, using broadband frequency to capture and transmit signals from the computer. (See The interference issue.)

The interference issue

My hospital’s biomedical engineering team was hesitant to allow the use of portable plug-in modems because testing standards for commercial-grade products are less rigorous than those for medical-grade products. No standards exist for testing commercial products for interference with medical equipment, and insufficient information exists on whether plug-in modems can interfere with medical-grade technology, such as I.V. pumps, cardiac monitors, ventilators, and other devices used in critical care settings.

However, I witnessed patients using portable modems on eight separate occasions in a critical care setting over the course of a year and a half. To my knowledge, the modems didn’t interfere with cardiac monitors, ventilators, or infusion pumps. Nonetheless, more investigation is needed because of the scant data available.

In our pilot program, family members absorbed the cost of the portable plug-in modem, which has been replaced with a router placed under the ceiling boards. However, since the pilot program, the technology has advanced and newer devices are available. Now wireless technology allows easy access.

Keys to success

The key to a successful virtual visiting program is for participants to use an Internet server segregated from the main hospital network. Also, to prevent transmission of infectious agents, patients should use their own laptops. At our facility, families were willing to provide patients with laptops to reduce the risk of cross-contamination. To help ensure patient safety and privacy as well as organizational accountability, our facility developed policies stipulating which patients could use the technology and in what situations.

With or without a webcam, connective technology offers many benefits for patients and families. Healthcare providers should consider a virtual visiting program as a therapeutic intervention that improves patients’ psychosocial and physiologic well-being. Besides maintaining and extending the patient’s social network, the program allows caregivers to get a closer look at the patient’s world, giving them deeper insight into what’s important to the patient.

At the time this article was written, Linda Nusdorfer was a clinical nurse specialist at Toronto General Hospital, University Health Network, in Toronto, Ontario.

Selected references

Berwick DM, Kotagal M. Restricted visiting hours in ICUs: time to change. JAMA. 2007;292(6):736-737.

Eriksson T, Bergbom I. Visits to intensive care unit patients—frequency, duration and impact on outcome. Nurs Crit Care. 2007;12(1):20-26.

Marco L, Bermejillo I, Garayalde N, Sarrate I, Margall MA, Asiain MC. Intensive care nurses’ beliefs and attitudes towards the effect of open visiting on patients, family and nurses. Nurs Crit Care. 2006;11(1):33-41.

Thalanany MM, Mugford M, Mitchell-Inwang C. Visiting adult patients in intensive care: the importance of relatives’ travel and time costs. Intensive Crit Care Nurs. 2006;22:40-48.

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