MONTREAL — While hospitals were scrambling for ventilators, masks and gloves in preparation for a COVID-19 surge, many were also installing baby monitors in emergency departments and intensive care units.
Since all critically ill patients with breathing problems need to be treated as suspected COVID-19 cases, resuscitation and emergency treatment has to take place in a sealed room.
Although hands-free voice-activated technologies are increasingly common in homes, many hospitals don’t have them.
“As we were preparing for a surge in COVID-19 cases, we realized we were going to need a way to communicate from inside a room to the outside of the room without breaking negative pressure seals,” says Dr. Shawn Mondoux, an emergency physician and lead for quality and safety in his department at St. Joseph’s Hospital in Hamilton.
A system of “clean” and “dirty” teams has been adopted in many hospitals instead of the usual approach of “all hands on deck in the room,” says Mondoux.
With this new protocol they encountered a new issue: the “dirty” team of doctors, nurses and respiratory therapists in a resuscitation room needs to communicate with the outside “clean” team to get medicines, equipment or more help.
After simulating resuscitations of COVID-19 patients with different communication technologies, Mondoux says his hospital found that two-way baby monitors were the preferred tool.
He says their low-tech nature is an advantage as communications don’t need to be transmitted over a network and the monitors are inexpensive and hands-free.
Video capabilities, he says, didn’t add a lot and a simple audio monitor that allows for talking in either direction works well.
The “parent” portion of the monitor can be placed outside the room and the “baby” portion of the monitor can stay inside the room. That way the “clean” team can hear what is going on in the room at all times and can also talk back to those in the room.
“We did have to develop a new style of communication,” he says, describing how they began repeating back instructions “like truckers” to ensure the communication loop was closed.
“You can’t just nod or say yes on the outside of the room. You have to call back the instructionΓÇªwhich we probably should be doing in open (non-COVID-19) resuscitations anyway,” to ensure the message has been received correctly, he explains.
Usually, resuscitation rooms are packed with health-care workers playing various roles, but that number needs to be minimized for COVID-19 patients.
Dr. Kashif Pirzada, an emergency physician in several Toronto hospitals, says this lesson was learned from the 2003 SARS outbreak when a “super spreader” infected multiple health-care workers as a result of an intubation procedure.
While having fewer people in the room minimizes the exposure risk, other changes have also complicated the usual processes used in the emergency department.
More medications and equipment are kept outside the room, in order to avoid contaminating them unnecessarily, which means that those in the room need to call for supplies more frequently.
And decreasing the number of times staff have to enter and exit the room also minimizes the use of personal protective equipment, such as masks and gowns, says Paul Logothetis, a spokesperson for the McGill University Health Centre, whose Montreal Children’s Hospital’s pediatric ICU is using two-way baby monitors.
He notes that the hospital has glass partitions with each room, allowing eye contact between the health-care workers.
In the adjacent Royal Victoria Hospital, the ICU is already equipped with wireless intercoms, says Logothetis.
How a team communicates is always a critical piece to providing good care to patients, says Dr. Vincent Grant, medical director of the simulation program for Alberta Health Services. With more than 100 simulation sessions run in the early phase of COVID-19 preparations, he says, communication came up frequently as a challenge.
In addition to using baby monitors, other solutions employed by some hospitals include using walkie-talkies or white boards, writing on the glass doors with markers, and using tablets to link to in-room computers by video messaging, Grant says.
Pirzada says many hospitals came up with the idea of using baby monitors as a solution around the same time. As co-founder of Conquer COVID-19, a volunteer organization developed to help health-care organizations access needed equipment, he helped reach out to the business community.
“We knew this was an ask we could fulfil so we didn’t hesitate to do what we could,” says Sean Williams, vice president of merchandising for Babies R Us Canada. The company has now supplied more than 400 baby monitors to about 50 hospitals, from Halifax to Vancouver.
Baby monitors were also donated individually to hospitals and through other volunteer groups. “I drove around Hamilton and picked up about 20 monitors one day,” says Mondoux.
“I’m surprised that we haven’t built this into our resuscitation environments in a more practical way,” says Mondoux. “I can communicate across several hundred kilometres with the technology at the medical school when I’m teaching but I can’t do that in a meaningful way 12 feet into my resuscitation bay.”
He says he hopes hospital architects in the future will “think about how to communicate in the context of negative pressure rooms and sealed doors but also full personal protective equipment.”
— Michelle Ward is a pediatrician, associate professor and journalist in Ottawa
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