2021 update: Re-uniting families with person-centred virtual visiting | from NHS Greater Glasgow and Clyde

Update from the team and plans for the future

What is it?
In the context of restricted visiting during COVID-19, NHS Greater Glasgow and Clyde developed a system of virtual visiting. In total 600 iPads (two per ward) were provided to allow people to speak with their families and friends.

Ensuring access
As with many innovations involving digital access, there was a need to ensure that there was equal access to the service. This was supported through:

• Investment in devices to ensure patients without access to their own personal device were able to access a hospital device.
• Use of communication tools apps to ensure non-English speakers and those with other communication needs were able to access the service and devices.
• Speakers/microphones were purchased to meet the needs of people with impaired hearing.
• Carts were purchased to allow adjustable height and position of the iPad for people with cognitive or limb movement issues.
• Learning needs were addressed with how-to-guides and access to verbal support for those not so familiar with technology.

Feedback
Staff have noticed that this has improved morale of both staff and patients. The daughter of one patient said:

"This has been such a boost for my family and I will always be grateful to the amazing GRI staff."

Another family member commented that:

"They were my family's lifeline. We would have been lost without the calls and I cannot express how much they meant to us and how grateful we were for them…We are also grateful to the student nurses who sat with mum during our calls to ensure that the iPad sat at the right height so we could see her and she could lip-read our words- they also helped decipher some speech."

One staff member described one of the benefits of seeing people talking with their families:

"I dealt with a couple of calls that the patients had no English, this really affected me and the staff that had gathered round to see the workings of it all. To see these normally quiet and subdued patients come alive was a joy to watch and especially made me more determined to set up calls when I could."

Ongoing benefits
As visiting restrictions are lifted, there remains clear benefits of virtual visiting, such as:

• helping people whose family are not in the area or who cannot visit in person
• having shared conversations with the person, family and allied health professionals around discharge planning, and
• supporting accessibility through interpretation and speech to text apps.

While many people have means to contact family and friends remotely through personal devices, initial scoping for this project revealed that on some wards, up to 50% of people don't have access to their own smartphone or tablet. Therefore, providing the devices and support to contact family and friends, through this initiative will still be important once COVID-related visiting restrictions are lifted.

Building sustainability
The virtual visiting service was developed rapidly in a responsive fashion.

Current effort is on developing sustainability of the service through embedding the service into wider processes and working closer with e-Health to ensure the service is efficient and safe in the longer term. Developing a more consistent approach to processes will allow for better monitoring of usage, quality and feedback, supporting ongoing improvements where required.

Embedding the service
Opportunities have been identified to introduce virtual visiting during admissions conversations, as part of a broader conversation including in-person visiting, who matters most to them, and how they would like these people to be involved in their care.

Safe and efficient
Work is underway to formalise the relationship with e-Health who can offer technical support that is currently done in an ad-hoc way by ward staff.

Information governance approved the use of apps including Facetime and Skype in the context of the pandemic, which requires to be revisited to ensure appropriacy of use post-COVID. This includes additional apps that can support wellbeing and spirituality.

There could potentially be a role for volunteers to support people to use the iPads during virtual visits.

Consistency
To date, visitors have been able to contact wards directly, or to use a centralised booking service when organising virtual visits.

Longer term as the service is embedded, we would expect all visits, whether in-person or virtual, to be planned between ward staff, patients and families.

Understanding experience
So far there has been feedback from families and staff. However, the team would like to find out more from patients regarding their experiences.

Reflections
Rachel Killick, Patient Experience Public Involvement Manager at NHS Greater Glasgow and Clyde, reflected that "setting up a virtual visiting service like this would not have happened so quickly before", noting that this is a great opportunity to further build on this. Rachel also noted that this is an opportunity to highlight the importance of investing in person-centred care.