Sir,
Effective communication skill is key to effective critical care management. Ever since the concept of informed consent appeared, the concept of communication among the health care professionals and with the patient's family has taken a new meaning. Effective communication should be precise, clear, comprehensive, and two-way. Apart from technical and emotional aspects, communication in an intensive care unit entails ethical issues also.
The COVID-19 pandemic has mandated several changes in clinical practice. One of them is the use of personal protection equipment or the isolation suits in the operation rooms and intensive care units. The protection provided by these suits to health care professionals have not come without a price, though. Not only it denies access to amenities like food, drinks, and attending to nature's calls, but also it has limited the use of basic equipment like a stethoscope. Another major issue encountered due to these suits in critical care settings is the problem associated with effective bedside communication among the health care professionals.
Use of pen and paper or electronic note books may be useful in these settings, but only in a limited way. A recent article has suggested use of intercom and dedicated smart phones.[1] Others have described use of a printed “Call airway Team” card for difficult intubation, use of walkie-talkies, and communication white boards.[2] However, these measures have their own limitations. Fogging of goggles or face shield are known to hamper the vision of care givers in the intensive care units. Difficulty in writing or using communication devices while wearing double gloves may also be an issue.
We suggest developing a sign language to overcome these problems. As it is also difficult to appreciate facial expressions while donning an isolation suit, only hand signs can be used to convey any message. Hand gestures are frequently used and is an expressive gesture used by us. As most of these communications involve technical terms, dosages etc., the novel communication method must address these issues also, apart from being easy to learn for health care professionals.
One of the available templates for developing this communication method is the sign language used by people with speech and language impairment. Hand gesture recognition is known to provide an intelligent and natural way of human computer interaction, which is a branch of artificial intelligence. By converting hand gestures into mathematical algorithms, it may be possible for us to communicate not only with each other but also with the machines and computers that we use in our health care setups.
The pandemic is here to stay. Some more might appear in future. With the increasing role of critical care physicians in managing these illnesses in a constrained environment, developing a novel communication technique is the need of the hour. Frequent communication among the healthcare workers in the highly stressful setup will also help in providing emotional support, encouragement, and appreciation to them.
Financial support and sponsorship
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Conflicts of interest
There are no conflicts of interest.
References
- 1.Mojoli F, Mongodi S, Grugnetti G, Muzzi A, Baldanti F, Bruno R, et al. Setup of a dedicated coronavirus intensive care unit: Logistical aspects. Anesthesiology. 2020 doi: 10.1097/ALN.0000000000003325. doi: 101097/ALN0000000000003325 [Epub ahead of print] [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Liew MF, Siow WT, MacLaren G, See KC. Preparing for COVID-19: Early experience from an intensive care unit in Singapore. Crit Care. 2020;24:83. doi: 10.1186/s13054-020-2814-x. [DOI] [PMC free article] [PubMed] [Google Scholar]