Commitment to evidence-based clinical inquiry projects guides innovation and creativity during COVID-19

Reviewed by Emily Henderson, B.Sc.Oct 14 2020

The COVID-19 pandemic has brought opportunities for rapid innovation and creativity, as healthcare professionals seek ways to maintain high levels of care for patients and their families.

But urgency, sudden change and new approaches do not mean sacrificing a commitment to strong clinical inquiry or straying from proven processes in the search for solutions, according to an article in AACN Advanced Critical Care.

"COVID-19: Mobilizing Quickly for a Rapid Response" describes how Duke Heart Center followed a proven process as it developed a clinical inquiry during a short time frame, as it quickly adjusted to the pandemic.

Co-author Mollie Kettle, BSN, RN, CCRN-CSC, is clinical lead, Duke University Hospital, Duke Heart Center, Durham, North Carolina.

Even in the midst of a pandemic, we must continue to deliver care that reflects the best scientific evidence. We must use our skills, creativity and ingenuity to develop ideas, to study what we are doing and how we are doing it, and to determine, in the midst of a crisis, how to measure the care we provide in order to make it even better."

Mollie Kettle, BSN, RN, CCRN-CSC, Study Co- Author and Clinical Lead, Duke University Hospital

Faced with the sudden implementation of a strict no-visitation policy due to the pandemic, the intensive care unit (ICU) team quickly requested devices and technological support to pilot video chats in the cardiac and cardiothoracic surgical ICUs. The hospital's incident command center approved the request the same day.

The resulting initiative, "Use of Video Chat to Facilitate Communication Between the Healthcare Team and Loved Ones in the Intensive Care Unit," addressed the clinical problem of how to deliver high-quality, effective communication to patients' families in the context of visitation restrictions.

A workflow and protocol for the video chat process were not readily available, so the team created them. The team also developed a virtual visitation communication tool to support consistent collection of data from patients and their families and from healthcare team members.

The need for a new role to facilitate the day-to-day work associated with telecommunication and data collection was identified, proposed, approved and implemented within the week. With the postponement of elective admissions to the ICUs and a subsequent decrease in ICU census, two nurses became available to fulfill the facilitator role for 12 hours a day, seven days a week.

Colleagues from the university health system were engaged to prioritize a literature review and recommend appropriate study designs and measurement instruments. The partnership provided expertise in creating a formal study design and expediting the institutional review board approval process.

The first phase of decision-making addressed which video chat application was most feasible. The team decided to pilot the process with FaceTime and Zoom, since they were the most user-friendly and supported by various cellphone carriers.

A second, concomitant phase involved creating a workflow and documentation process that was flexible and could adapt to the unique communication needs of the two ICUs and their respective patient populations. The detailed workflow included communication scripts and special patient intake forms.

Rapid staff education and training, as well as rapid initiation of the new workflow, were required because of the sudden change to no in-person visitation.

In less than 10 days, the team created the design; developed the structures, processes and outcomes; and performed the final steps of staff training, institutional review board approval and implementation.

This process demonstrates that teamwork, collaboration and creative engagement of people and resources across clinical, administrative and academic partnerships can help work groups efficiently conduct evidence-based clinical inquiry projects within short time frames.

The article is one of several articles published in the fall 2020 issue of the journal that addresses different aspects of COVID-19. Other articles include:

• "COVID-19: An Immunopathologic Assault," which is part of a symposium of articles about uncommon conditions in today's ICUs
• "Drug Update: COVID-19 Therapeutics: Making Sense of It All"
• "Technology Today: COVID-19 and the Silver Lining in Health Care Technology"
• "Ethics in Critical Care: Applying E-PAUSE to Ethical Challenges in a Pandemic"