With iPad, COVID-19 patients see the caregiver behind the mask

When the staff at Stanford Health Care’s Marc and Laura Andreessen Emergency Department started connecting with patients in isolation via iPad, they found an unexpected benefit: The approach offered a more personal, human-centered experience.

“Far from separating us from our patients, it is actually expanding on what we can do,” said Ryan Ribeira, MD, clinical assistant professor of emergency medicine at the Stanford School of Medicine.

Emergency department staff started using iPad devices on March 28 to help care for confirmed or suspected COVID-19 patients in isolation. Each time a physician, nurse, interpreter or other caregiver enters an isolation room, he or she must put on a paper gown, two sets of gloves, goggles and a mask that obscures much of the face. The process, which requires five rounds of handwashing at different points, often takes more time than interacting with the patient.

It’s not much fun for the patients, either: They see goggles and masks instead of faces, an experience so disconcerting some caregivers have taken to affixing photos of themselves to the front of their gowns.

But with the 120 centrally managed iPad devices, caregivers can conduct a visit as long as it doesn’t require hands-on care. The devices in the patient rooms, mounted on mobile carts at the patient’s eye level, connect with those installed at physician and nurse stations in the emergency department.

Check-ins via iPad range from a simple “How are you feeling?” to physical assessments, such as asking patients to open their mouths or move their eyes. Specialists and interpreters, if needed, can join the call. Patients can also call the nurses through the devices.

When a critically ill patient requires hands-on care, many of the consultants, specialists and nurses — such as the one taking notes — can visit remotely. Only three or four caregivers, instead of nine or 10, need to enter the room.

After they began using the devices, caregivers almost immediately noticed patients were more connected when they could see physicians’ and nurses’ faces, including their smiles and expressions of understanding and reassurance.

Reduces need for protective equipment

Caring for patients remotely greatly reduces the use of protective equipment — an estimated 80-120 sets per day. The risk of exposure has also been minimized for physicians, nurses and other caregivers, particularly those who are pregnant, immune-compromised or otherwise at high risk of complications from COVID-19.

The iPad project moved from conception to implementation in just eight days, starting with a drive-through program in a Stanford Health Care garage: Patients remained in their cars while a physician assessed them by video from inside the emergency department.

To bring the program into patient rooms, technology specialists at Stanford Health Care ensured the tablets had necessary features, such as the ability to auto-answer calls. When a caregiver calls to check in, the patient receives a few rings as advance notice, then the iPad answers itself.

The iPad has also been paired with portable handheld ultrasound scanners that quickly plug in, eliminating the need for a bulky ultrasound cart that requires decontamination after every use. And patients participating in clinical research can consent via iPad.

Before the pandemic hit the Bay Area, ED caregivers had employed remote-care video in a handful of rooms; now there is an iPad in almost every patient room in the emergency department. Physicians and nurses are exploring ways to use the tablet computers after the pandemic: to speed up consults, patch in interpreters and include family members in patient care conversations.

The devices “provide a rapid way to check in on patients,” said Patrice Callagy, RN, executive director of emergency services. “They also show the great collaboration between multidisciplinary services. When someone comes up with an idea, we go with it.”