 with the Patient Safety Movement Foundation. Welcome to another COVID-19 update. Today, we're gonna be talking about engaging families of hospitalized patients during this pandemic. And I'm very excited to be joined by several panelists today. We have Jan Matthews, who is a wife of a patient who's recently discharged from the hospital. Jan, are you on the line? No, I don't think she's with us just yet. Okay, and I can hear you, thank you, Jan. Jan, tell us a little about yourself and then we'll have all the other panelists introduce themselves as well. Okay, I live in Temecula, California, which is right between San Diego and LA. We're a community of about 300,000 and we have, I think, pretty good medical care here. And my husband and I have lived here for at least 20 years and we've been married for 40 years. So it's been a long-term thing and he's been quite ill over the years with heart disease. So I'll tell you more later when you're ready to hear. Thank you, Jan. Vonda, tell us a little about yourself. Good morning, everyone. I'm Vonda Vaden-Bates and I come to the Patient Safety Movement Foundation following the death of my husband in 2012 from a preventable and hospital-associated venous thromboembolism. And I sit on several committees, including the person in family engagement, actionable patient safety solution as co-chair with Marty Hatley. Thank you, Vonda. And Rachel, would you like to introduce yourself? Rachel, are you there? Okay, how about we will make sure that we get Rachel unmuted and move on to Tim. Tim, are you there to introduce yourself? Okay, well, we appear to be having some issues with muting today, but that's all right. We'll move on and we'll have our panelists introduce themselves as they join. All right, well, as you know, we've been doing our COVID-19 updates and focusing on general information. Today, we thought we would focus on a very specific issue because of the COVID pandemic, hospitals are restricting visitation. Very often, the exceptions are only for end-of-life care or for labor and delivery. And this has caused quite a problem in the United States and elsewhere around the world. We've been working for several decades now to improve person and family engagement because we know that when patients and their families are involved in decision-making and involved in the planning of care, then patients have better outcomes. And we've shown that time and time again, and many hospitals have successfully improved their engagement of patients and families through things like interdisciplinary rounds and patient and family advisory committees. And most hospitals now have a patient experience department to interact with patients and families. But right now, currently, patients are alone in the hospital and they don't have that advocate at their bedside, which we know could lead to higher rates of medical error. So patient safety is very much at risk right now. And so we'd like to start with getting everybody to understand exactly what's happening in hospitals today. So, Chan, we would love to hear your perspective about what it's like today to be in the hospital with COVID or be the family member of a patient that you can't get into see. Chan? Am I, can you hear me now? We sure can, thank you. All right, a week ago today, my husband had a replacement of his pacemaker at Scripps in La Jolla, which is just south of here. It was a, he had to have it because the battery started to go down. So even though they had restricted surgeries to just emergencies, this was considered one. During the, it was supposed to be a just a day surgery thing. When he came home, he was having trouble breathing but we kind of expected that because he had stitches and he had been under general anesthesia and he has had heart issues before. And they also did an ablation. So he had two surgical sites on him. During the night, he became really, he couldn't lie down. And so I did call the doctor's office very early, like one sixth in the morning and described his symptoms. I did not talk to his actual surgeon, but someone else. And they said, you've got to take him to the emergency room. So I had a friend drive us and we were going to take him to Scripps but he was having so much trouble breathing. He said, I'm not gonna make it. So we took him to the local hospital. When we got there, they accepted him into the emergency room, but I was stopped at the door. They gave me a piece of paper to put on my name, his name and a phone number. So I did that. After that, that was it. He was in respiratory distress and they had to triage him immediately and they put in a chest tube because during the surgery, they had punctured his lung, but it wasn't detected. And so his lung collapsed and it was on the left side. So it put extreme pressure on his heart, which is already compromised. So hours went by, I didn't hear anything. I called, I couldn't get anyone to tell me anything. And it was only later that day that I called him. And even though he was on morphine and was very drowsy and in a lot of pain and so forth, he managed to tell me what happened. But I couldn't talk to any doctor and it was only the following day that when he was in a room, he was in a PCU, which is progressive care. I managed to talk to his cardiologists who happened to be standing there. And they did not even know that he had had an ablation the day before. They were completely devoid of information. They didn't have a medication list. He really wasn't able to express himself very well, but no one called me and tried to get his medical history. It was so distressing to find out that they were just kind of flying blind. They saw that he had a surgical site on his chest, obviously, but they didn't even have the number of the pacemaker or what was going on with the pacemaker. And they were very confused because for some reason I could detect his heart rate kept changing and his blood pressure would go down really low. So they didn't really know what was going on. Unbeknownst to them, the cardiology, the surgeon had set the pacemaker a little differently than normal to account for the ablation they did. But since they didn't know any of that, they were trying to figure out what was wrong with them. So I had called, Vanda had helped me contact the patient advocate to try to find out more. And, because I wasn't getting any calls from doctors, nurses, and I was barred at the door. There's nothing I could do. So I called the patient advocate line. They are not open on the weekends and they said they'd call back. Monday came, they never called. So on Tuesday, Vanda got numbers, helped me try to find somebody and they still didn't call back. So then I managed to get ahold of my husband, found out he had been up the entire night before, not able to lie down. What happened is that the chest tube they put in either got dislodged or stopped working. I still have not found out exactly what happened. And so his lung collapsed again. This time they put him into a surgical unit and replaced it in a different location with a much better tube and more MRI kind of guidance to really help him out. It took him a couple of days to actually recover to the point where he could talk to me. In the meantime, I was calling, trying to talk to nurses. They were too busy to talk to me or they said, we'll call you back. And I just, it was unnerving, it's just maddening not to be able to get information on my husband's condition. 77 years old and there was virtually nothing I could do. I was completely shut out of the process. And I have a few recommendations, as we go along in our discussion, but he could have died and I almost did die. So that was it. Wow. And he came home last night. We couldn't wait to get him out of there. I'm watching him like a hawk. I know what to look for now if his breathing becomes trouble. I have a spirometer here and I have an oximeter so I can start to track him. I'll be a better watchdog for him than anybody in hospital. That's very, very true. And that's exactly why patients need advocates out their bedside. Thank you so much for sharing your story. Welcome. It sounds very, very frustrating. And I know though that our clinicians that are in the hospital, our administrators that are in the hospital are also feeling the impact of restricted visitation. Tim, do you want to tell us a little bit about what they're feeling right now? Sure. We've had lots of conversations with both the administrators and the clinicians. And this is a particularly difficult time for all of them because they're doing things that they've never done before. And they are, it's just, again, a terrible experience. Hospital administrators are frustrated because they don't have enough of the kinds of equipment that they would like to have. There's huge concerns obviously about ventilators. And we're even hearing stories. And I heard a little bit of this from Marty and some of our connections to hospitals here in Chicago that you'll have one nurse on one unit who develops COVID-19 and then you lose an entire shift of nurses that needs to go into sort of isolation and quarantine. And so staffing becomes a complete nightmare. From the clinician perspective, they are scared. I heard a quote the other day, and I think, again, Marty, you may have shared this, is in the past with patient safety, people used to say when it comes to the aviation model, one of the reasons why we may not see the same impact on physicians as pilots when it comes to safety is that physicians aren't at the site of the crash, but now they are. And so it's created a whole different awareness on their part about their own vulnerabilities. They're also very, very frustrating as well. Frustrated as well about having to tell, again, patients and families that they may not have contact with their loved one. And that is just so contrary to the Hippocratic oath and doing more harm. And so there's a lot of this that's going on. The other part is they're confused. The clinicians are. The mixed messages are all over the place with regard, and we even heard today there may be a new message coming out about wearing masks in and out of the hospital and things like that. So there's just a lot of confusion, there's a lot of fear, but there's also a lot of love for each other and for their patients. And what we're hearing is they're all trying to do the right thing. And that's one reason I really like having these webinars because hopefully we're gonna be sharing some best practices out there. So I'll turn it back over to you, but that's in general just some of the stuff we're hearing at the front line. Thanks, Tim, appreciate that perspective. Yeah, we are gonna be talking about some recommendations next. And Vonda, tell us a little bit about what we're gonna be talking about today and how are we going to develop the evidence that we need to figure out how to handle this? Thank you, Donna. And I wanna just say to Jan, walking with you through those days was horrifying for you and for Dick, I know. And it prompted me to pick up the phone with several of the people who are on the line here today and just convey that situation. And Donna, Olivia, Marty, several of you, I just wanna say that the foundation here is so nimble and it's so impressive that within four days you can take a situation and move it into a webinar like this. But this webinar is really focused on several goals today that I am hoping that we can all pay attention to. First and foremost is just to remember the prioritization of the communications with the practitioners or clinicians, the administrators of these healthcare centers, be it a hospital or otherwise, and that patient and family member. And we've learned so much over the years. There is ample evidence-based research to indicate how critically important it is. It is not a nice to have, but a must have. And during times of stress like this, it would be easy to put this on a lower priority. And it's my hope, and I think it's the hope of several here today, that we set a goal of prioritizing the communication strategies. And you're going to hear several ideas from experts who are very close to the patient and to the healthcare centers today. But I also hope that a goal for each and every one of us today will be to listen very, very carefully for understanding several different perspectives as we continue to design and design engagement at a distance, really, and to have continuous learning. We are able to provide these perspectives because of the great work that's been done over the last many years. And it's available, but it has not been converted to the situation that we are in now. So it's being converted on the fly, and there will be time today for your comments and questions so that we can continue to improve the suggestions and recommendations that are being made today by the experts and by the people who are having direct experience. Lastly, I just wanna make sure and point to the person and family engagement, actionable patient safety solution. As a guide, there are a number of links there and we can utilize existing resources today. Like COVID, we are learning how much can be done when we all make a decision to focus on one thing together, how much we can expedite actions and new behaviors. And it's my hope that we learn from this in a way that helps us also expedite the learning that we have around person and family engagement and all of the safety solutions that are emphasized within a patient safety movement. Thank you, Donna. Thank you, Vonda. That's an excellent set up for what we're gonna be talking about today. And Rachel, she was muted before and unable to introduce herself. So Rachel, could you introduce yourself and then tell us a few recommendations for what patients and families can do at this very difficult time? Sure. Can everyone hear me okay? We sure can. Wonderful. So good morning, everyone. My name is Rachel Weisberg and I am a patient family engagement advisor. I've had actually a career in patient safety and hospital quality that predates my own experience as a patient. But I am gonna speak to you now as a patient with three health conditions that I've acquired in the last 15 years of my life. One of which has meant a lot of emergency care in hospitals all over the country. I also have a brother who's currently fighting the coronavirus and who was in the emergency room earlier this week because he's struggling to breathe. So I'm gonna briefly talk about some strategies that I've learned and recommend patients use when dealing specifically with emergency care. I think the overall thing I wanna emphasize is that emergency care situations, as we all know, are very stressful. Often the pace of care is more rushed than in an ideal environment. And as a result, providers tend to communicate less with patients because they're in a hurry. Patients and families need to recognize going in that they have a responsibility to help with this. It's helpful to think about all of these points as I sort of like to group them all under the golden rule due to others as you would have them do to you. So all of the behavior that you want from your provider do that to them. So my first point is communicate useful information. The doctors and nurses don't need your life story. They need whatever information will help them take good care of you. Things like, why do you feel the need to come to the hospital? Did your symptoms change? Things like that. My second point is advocate for yourself. Speak up if something feels wrong, if you need help or assistance. I've found that when I have to wait a long time for help in the ER or to get relief from medicine, little things like even a warm blanket or a cup of water can help to ease my anxiety and help me to feel cared for. Don't be afraid to ask for these things. Prepare another thing that I'd like to do is try to prepare questions. I have an advance of when the doctor comes by because you just never know when that's gonna happen. They're gonna be in a hurry. So figure out a way to record their answers. The easiest way to do this I've found is simply just record it on your cell phone. Always ask their permission to do that. Usually they're fine with it. But if not, maybe ask a nurse to take notes for you so that you can have that information after you leave the hospital and after you're discharged. My third point is be kind. Be kind and practice gratitude. A couple ways to practically do this is thank your caregivers often. Remember their names. Use their names whenever you speak to them. I'll tell you a little bit about my brother's experience. He said that being in the ER, he was actually only there very briefly. He went because he was really struggling to breathe. He ended up being discharged because he didn't actually have pneumonia. So they gave him some prescriptions and sent him home. But he said that he felt very toxic being there because he has this contagious disease and he was extremely conscious of, you know, he was admitted to someone and it made him feel almost guilty for being there. Everyone is so completely masked and covered up that he couldn't even see his doctor's face and the doctor didn't even enter his room. So there's no real bedside manner. And while this may be necessary, patients have the opportunity to help humanize the situation. Another way to do this is to simply state your feelings. If you're scared, it's okay to say you're scared. I suggest that, you know, if you say something like, I'm scared, maybe you're scared too, you know, but thank you for being here. I recognize that, you know, that this is a risk that you're taking. You know, now more than ever, we need to be generous with one another. And my closing thought is simply being present can help with a lot of the anxiety that comes with being in an incredibly stressful situation like receiving emergency care. For those of you who practice any kind of meditation or yoga, you'll find this concept, you'll probably resonate with this. So I've found that consciously trying to sort of breathe through my body in those times has really helped. Simply because, you know, when you breathe slowly, it takes your brain out of its fight or flight mode. Before my brother went to the ER, he actually called me and he had me stay on the phone with him so that I could help him do that. Just help him sort of help him like breathe in, breathe out, breathe in, breathe out. And of course that's even more important because this is a disease where it causes you to be literally short of breath. So, you know, that even causes you to panic even more. So just something to think about. Those are really great, great recommendations. Thank you. So that's what I have to share and thank you so much for letting me sort of share my little, my strategies. Yes, thank you. And I'm sure that we'll have plenty of questions for you as we get closer to the Q&A section. One thing that we're very excited about here with the Patient Safety Amendment Foundation is we have a couple of new tools for you that we have put together that could help families to manage this situation. Vanda, do you wanna talk a little bit about this new infographic that we've created? Sure, Donna. The first, there are three pieces here that I think might be helpful. And this is when I said earlier and asked this audience to just please listen carefully and weigh in both on the call today during the Q&A but also following these are under development. So what you're seeing here is a first draft that was developed by individuals who have quite a lot of subject matter expertise with regard to engagement between the healthcare clinicians, administration, patients and family members. The first is an infographic and it's a very simple guide to what to think about through the process. So beginning with admittance, if you have the grace of being able to know that you're going to be admitted, you could print this out ahead of time. If not, it's something you could print when you get home or even it's designed in such a way that you could just pull it up on your phone. There are several suggestions including some of the suggestions that I think Jan would have made or has made to me, not just to get a general phone number, for example, to the hospital, but to give your patients and family members a direct dial number in the long run, I think giving direct contact information will save time because otherwise you're constantly trying to respond rather than be proactive in your communications. And one of the things that I think we have all learned within patient and family engagement strategies is that a proactive approach does save time and it saves lives. And so that's the emphasis here. And Donna, if you want to move to the plan of care or which is referenced on this, this is an example of something that you might be able to take a look at that just uses SBAR for those of you who are on the patient family side, SBAR stands for Situation, Background Assessment and Recommendations. And this hospital plan of care is something that could be created by a hospital care center. It could be printed out and utilized by a patient or family member as well. And it really just sort of looks at some of the basics that you might be needing in order to both be admitted into care but also to sustain that care over the number of days that someone is in the stay. And then there is a third sheet there and I can't see it on the screen anymore because we just switched over, I think to Tim's. I think that might be my cue. Do you want to go to the next one real quick and we can show them that third piece? You'll notice there that some of the common safety issues are listed here. And these are things that patients and family members may not know to look for but we certainly know and can anticipate those from the clinician side. And again, just taking a proactive approach can be very helpful. Donna, did that cover everything that you wanted to cover in that segment? It did, Vonda. And I apologize that apparently we are linking to the same form in all three of these. We'll fix that before we send it out to everybody. And so thanks for covering all of that information. Olivia was trying to show her screen and show you what an example of that form would be. We are also gonna make sure on our website that we've got some very clear directions about how to use this tool. Cause the idea is that the family could be at home and managing the plan of care from home through conversations with the clinicians. So we'll be sure to have those links fixed before we put this up today. Thank you very much, Vonda. Okay, so Tim, can you tell us some recommendations that hospitals can do to mitigate this problem of limited visitation? Well, certainly. And as you can see from the slide there I think it's really important now more than ever to really engage with your patient and family advocates, your patient and family advisory councils to really work closely with them in sort of a shared decision-making model to ensure that we're meeting the needs of everybody at this time, but also trying to maintain a safe environment. Excuse me, there are a lot of very, again, clever things that are being done related to technology about trying to keep people connected. I saw one of the comments in the chat that again, now more than ever we need to think about the really vulnerable patients. The patients who are hearing impaired or family members who are hearing impaired, where, again, English may not be the primary language. We really need to begin thinking outside the box to make sure that we're helping those really vulnerable patients during these times. And some of that depends on the virtual connection services. And telehealth has become a much bigger way that people have started communicating. I've seen just massive increases in that around. And again, as you can see there, what the Kaiser ICU's are doing and many of the other, again, organizations are trying to figure out clever ways to do this. Necessity is the mother of invention and we're seeing a lot of that right now in terms of what people are doing. So the other thing, as you can see here is boy, having smartphones can be really wonderful, particularly when you're trying to create or do FaceTime. Again, more and more people are doing that. And have your volunteers help with some of these situations. We have definitely seen a big increase in the use of Zoom to do, again, these virtual meetings. And I'm a big fan of those interpretation service devices. And remember, one of the ones that's a little harder to use, but we need to think about it, are those for the hearing impaired? Again, it may be very difficult when we're trying to interface between the family and the patient who may be in the hospital with limited visitation. We really need to be mindful of, and again, the need for clear communication related to the visitor policies and combining that, we absolutely need to have empathy more than ever in terms of what it is that we're doing. And that gets into this whole piece of it. And this is a part I've been super, super engaged in. And that is in the teaching of empathy. Here, as you can see, Carla McLaren, I highly recommend this book to everybody, especially in these days. She talks about the art of empathy. And the definition, as you can see, the first part of it is just super important because it says empathy is a social and emotional skill that helps us feel and understand the emotion, circumstances, intention, thoughts, and needs of others. So that alone is really important because it means, since it's a skill, we can teach it. And so over the last two weeks, we have been developing a lot of online teaching material about being empathic during the COVID-19 times. And in fact, we've got a big webinar that we're gonna be doing next week with the Healthcare Quality Institute and the Beta Healthcare Group where we're gonna be doing a large webinar to show how do we go about during these times providing empathic communication to patients and families and their loved ones but also to the teams that are suffering as well. And here's one of the slides that we like to use to drive home to people, the importance of this. A lot of these you may be aware of if you're familiar with Brene Brown. She has an incredible Netflix special that she does and she really talks about now more than ever, we need to connect, we need to be present and we need to be vulnerable. We need to bear witness to the hell that people are going through, both patients and families as well as the caregivers with this and to not judge people for the intensity of what their feelings are. Their feelings are their feelings and we need to recognize that and we need to say yes to their experience and not necessarily try to fix it per se because it's so hard to fix that the tragedies were seen. And so part of empathy is just being there with people and letting them know we will be there with them. Next slide that you can share. So here we talk about the ability to use some videos we've created over the last week with a group of actors in Chicago who fortunately live in the same loft. They're related to each other and they're able to create some of these incredible videos that we're now using for training. And in this particular scenario, it was built out of what we're hearing from all of you, which is this is a case that involves an emergency department physician who becomes a patient with COVID-19, has a very long history, 30-year history of insulin-dependent diabetes, ends up coming into the emergency department and immediately it is noticed that he needs to be intubated. Of course, there's that separation from this person and his spouse, both of whom work in this ED. So again, this is one of those circumstances we're hearing more and more about, which is we're having to take care of those we love in the workplace now become our patients. And so the scenario is one where the patient's been intubated right before he's intubated, he tells the doc and the nurse that he does not wanna be on the ventilator for more than two days. He's got horrible comorbidity. He realizes his survival likelihood is low and he's fearful of the fact, and we've read this from others that he's going to be consuming valuable resources. And he wants that communicated to his wife. The other thing you need to communicate to her is gonna be the fact that she's not gonna be able to visit face-to-face because of the visiting issues related to that. And so how do you empathically share that as well? So the scenario you're about to see involves the nurse and the physician coming in to speak to the spouse in a quiet room. They're all very good friends. And this is a series of questions. You can go to that next slide. When we do the training, we highly recommend people think about this when they're going in to have these kinds of often very difficult conversations with patients and families when these horrible things have happened. This is also the kind of questions we want people to ponder when a mistake, not just COVID-19, but when a mistake happens, how do you communicate it? So one of the first ones you see there is what we've been talking about is, are there any special personal or family dynamics, disabilities, language, any of those issues, where you need to consider it before you go in and speak? We did a big training in St. Cloud, Minnesota. Marty was there with me. What's unique about St. Cloud is is now 50% of the babies there are born to Somali moms who don't speak English. And so ahead of time, you really need to be thinking about as an organization, some of these issues. And then you can go through and you can see the rest of the questions. One of the most important ones that I have highlighted there is in red. And I think this is one of the most powerful things to use when we are engaged in empathic communication. And this is even outside of COVID-19 or healthcare. It's when we have information in our head, we need to share that is going to be difficult for the person we're sharing it with to hear it. It is often super, super helpful to prepare them that they're going to hear something that may be very unsettling. So again, saying things like what I have to tell you may be very unsettling. This may be very difficult. And then think about what emotions do you anticipate and how do you name and validate them? Now more than ever, it's important that we recognize the emotions that patients, families and loved ones have and how we're going to name and validate them. But also when we're supporting other members of the care team, you know, how do we do that? And you really need to be prepared for questions that you might get. And one question that we hear over and over again, and this is something that I learned a lot again from Marty Hattley, is that often patients and families and particularly parents of children who are suffering, is the feeling that they may feel guilty? In other words, did we work? Did we bring this person in too late? You know, did we miss this? And again, parents often will feel that about their children. Did they bring them to the wrong place or the wrong doctor at the wrong time, what have you? Well, we really need to be thinking about that and make sure that we let them know that their feelings are normal, but that we can reassure them that they've done the best that they can. And these are just, again, some of the other questions you have there. So again, I'm gonna play this video. It's about six minutes long. This is some of the, one of the things that we are creating for the training that we're doing. And we have a whole bunch of these vignettes now that we have created that, again, we're trying to make available for these webinars and to do that. I'm gonna go ahead and share my screen here and I'm gonna go ahead and play this video. Again, when you look at the video that you're gonna see here, it is on the right is the wife of the patient who was just brought in who's just been intubated. Straight ahead is the physician, the ED physician and on the left is the nurse. And these people all know each other because they work in the same emergency department. But these are actors that are displaying, again, what they've learned by talking to patients and families throughout and, again, trying to convey how is it that we can provide empathic communication in these times? So I'm gonna play the video now. Tim, can you turn up the volume a little bit? The situation, I'm so sorry. We have to meet some of the specific questions. I mean, what's going on? What's happening? Tim, can you turn it up at all? Tim, I'm afraid we're not able to hear the video at all. All right. So Marty, when I shared it earlier, are you able to hear it? Are you not able to hear it? Because I have it up, Max on my computer. Yeah, Tim, I can't hear it. I can hear it lightly, but the volume's all the way up. We can share this link on our recording of this webinar a little bit later too. So this will be available online just after this webinar. Oh, okay. So somebody just put they can hear when they increase the volume on their computer. Oh. And someone else says they can vary. Let's try that then. I just turned my volume way up. Let's give it another couple of seconds and see if it's better. Okay. All right. Let me play it again and see if all you can hear it. Because I haven't. Yeah, I don't know. Marty, I don't know what to do. I have, you know, I'm sharing it in the same way that I did when we did the test. Well, could, Tim, we can share this on our website if that's okay with you and get it to everybody later on if that works. Yeah, I mean, we can, again, we can try to figure that out. I'm just thinking through here. This is obviously very frustrating. Cause again, we tested it ahead of time and you guys said you could hear it. Good. But Tim, you gave us a lot of really good information in the framing slides and people are commenting about it in the box. So delivered some great content already. Yes, yes. And perhaps Tim, you could just kind of summarize what the video would show. Right. So what it is, is that again, they acknowledge the hell it is for the wife to hear that he's had to be intubated and she even brings up, oh my gosh, it is, he's on a ventilator. I've been reading a lot about the ventilators and that's something we don't have enough of, right? And so they get into that conversation but they do then explain to her very empathically that what he says before he, just before the breathing tube goes in that again, he doesn't want it in for more than two days. And of course she's very unhappy to hear that but then they share the fact that, he did say I have these horrible comorbidities, I should not be the one consuming these resources and when they share that with her, they have this moment of recognizing that he's always been an other centered person and that that is would be just like him to be thinking about other people and they share that with her. And then they get into the part where they have, she then says, hey, can I please go in and see him? And she's not able to and they explain to her why for all the different reasons why not able to do that but then they also promise to allow her to FaceTime, they give her their own phone numbers so she can call them and they can set up periodic opportunity to talk to them but also with him. And then the other thing and as an ICU doc, this is one of the things that we learned how to do, they also share with her the plan of, he would be sedated to make sure he's comfortable while he's on the ventilator but there would be windows of opportunity where they could turn the sedation down so that they could allow him to connect with his wife. For brief periods of time, so he wasn't super uncomfortable but at least could have those kind of conversations. And then that's how they kind of concluded is being there for her, being present, bearing witness to what an amazing guy he was which was really an incredible part, she really, really wanted to hear that. And so that's kind of a summary of what we built out in sort of doing that. And then we just got a question here on supporting providers for resiliency. We have two big training videos that show how do you provide emotional first aid to that physician, that same physician in the same scenario. And then we have a great video. Again, Marty, I shared with you last night of sharing that providing emotional first aid to the nurse. And actually it was a chaplain who was providing this, again, this emotional first aid keeping their distancing between each other, doing that. Yeah, the final thing I would mention, and I just wanna put it out, we hear the term social distancing a lot. In the last 48 hours, what I'm hearing more and more is a desire that we think about abandoning that term and that instead we use the term physical distancing because we should never really socially distance ourselves from our loved ones, our patients and our families. And I kind of like that message. And so that's one of the other things that we're gonna be talking about in this HQI Beta Chipso webinar coming up next week is words have meaning. And I think that's a really important thing we all ought to think about. And I think it would be very cool to have the Patient Safety Movement Foundation come out and kind of in support of that. It's kind of like, we've abandoned the term second victim. I, listening to patient advocates everywhere, I really took that to heart years ago. And as Marty knows, we have eliminated that phrase in any of the teaching or training we do around the traumatized care providers. So Marty, I'd open it up to you to comment on that as well because you've been one of my mentors from the patient and family standpoint of words having meaning. And as Marty Hadley, would you like to make a comment? Well, sure. I was there when it was actually Jack Jettri's wife, I think Tim in Iowa, we were doing candor training who said, you know, that first thing you say really, really sticks in my mind. And so really think about those words carefully. It kind of helped me understand this notion of the shot across the bow. One of the things I was thinking is that is that you might give some specific examples here for this group about, you know, just what those opening lines could be. And then the other thing that really struck me as you were talking is just how often I hear from patients and families that they feel guilty or they feel like there might have been something that they've done or something that they've omitted to do that has put their loved one in that situation. So just being very, very cognizant of that when you develop that shot across the bow comment is almost listening to draw that out in some way. Do you have any practical advice there? Well, I mean, again, the introductory piece, Marty, is absolutely clear. And I also think, and this isn't to script it, I do believe that when you're going in to have some of these conversations, it can be very helpful to literally say Marty what you're gonna say to a colleague. And it does mean using some of those shot across the bow. You know, it's very difficult to see to have to meet with you under these terms. One of the things that's in the video I love that the nurse says is I would love to give you a hug right now, but unfortunately, as you know, I can't. So by beginning with that, recognizing the emotion and the angst that's going on, I think is very helpful. But any other way you can think about giving that what we would call that warning shot, that preparatory message about, we're about to get into a conversation that's gonna be really difficult or really hard to hear. And then the other key Marty I would say is, and you taught me this, is to listen. It is so, so important that once you've shared whatever the information is, is to listen. And there's a lot of that in the video where we often say, count at least to seven. That's the other tip we'd give after you have to tell somebody something that may be difficult to hear. Count to at least seven to give them a time to process it and to live within the silence. Silence can be golden. And somebody even says, hand to the heart. As you guys, many of you know, I worked in the Middle East for three years. That was a very, very common way that we communicated because even then before COVID-19, there were a lot of circumstances where men were not supposed to extend their hand to women. And so a lot of us got used to just in general chat put our hand over our heart, which I think is again, a beautiful tip that's there. Great. Well, thank you, Tim. We had another question that somebody had asked about whether or not these resources were gonna be available. And yes, they are. We, every week when we do our webinar, we will link all of the tools that we have in this presentation on our website. So you'll see that when we send out an email with the survey after the webinar is concluded. We don't have any other questions right now. So if, but we have just a few minutes. We actually have 10 minutes left. So if there is anybody out there that has any questions for the panel, then please go ahead and ask. While we're waiting for that, I invite anybody from the panel to give us any final thoughts that you might have about this situation. But what, what do you feel, how do you feel today now that we've kind of talked about this and gotten some really great ideas out there? How do you feel about tomorrow, any panelists? Donna, this is Vonda. And I'll just re-emphasize something that we spoke to at the beginning of this webinar. And that is that these documents that were created this week are intended to be continuously developed. And so I would just simply ask, if you do use these materials and you find opportunities for improvement, please don't hesitate to be back in touch with Donna and Olivia or whoever it is that you have a contact with here and make those suggestions because I think we are learning this and even though we have quite a lot of evidence-based research around person and family engagement, it is not designed, primarily not designed for these physical distancing strategies that we are having to cope with right now. And so, I think everyone has done their best to create a great first draft here. And we are definitely in recognition that there is room for improvement. And then the last thing that I would just say is that with regard to the anxiety that we often feel, there is a way in which we can also really take stride and hope, I think, in what we are learning and what our new behaviors are. There's quite a bit of research that says about a 28-day cycle of a new habituation, a new behavior does have some stickiness. And there is a way that these physical distancing strategies that we, most of us, are taking to heart right now give us an opportunity to create new behaviors and new system behaviors. So it is certainly my hope and I think the hope of many of us that we use these new behaviors to influence the system that is in place because what we certainly recognize is that people give care, but systems definitely shape the ability to give that care. So how do we use our personal new habits, if you will, to reshape the systems? Thank you, Vonda. One, you may be able to see on your screen, Olivia is sharing her screen right now and she's sharing the hospital plan of care example that we have. We will link a blank form as well as this example on our website. And so you can see that it is in the form of ESFAR, situation background assessment recommendations. And the intent here is that the family would maintain this document at home, perhaps with pencil, so that it can be easily changed. And so, and this information can be gotten from either the patient portal or from the nurse. And we will continue, as Vonda said, these are in development, we're gonna continue to make them better and we'll provide directions on our website for folks on how you could actually do this in your own home. Thank you, Olivia. Okay. Donna, can we invite our attendees today to help us make them better? I mean, I'm just thinking the conversations that I'm having with colleagues here are so different this week than they were last week. As Chicago hits the really steep incline, there'll be more and more people that are figuring out ways to communicate with a hospital. And we had somebody, actually more than one person in the chat box talking about maybe a brainstorming session about this. So let's keep that in mind and take that and see if we can make that happen. And I did float the structure of our documents too in the chat box. Admission during this day, discharge and post-discharge is kind of the way we're thinking about the different places that we have to be innovative in communicating. So we'd love some feedback on that structure too. Yeah, absolutely. We definitely are interested in hearing anybody's feedback about how we can make our tools more robust and our actionable patient safety solutions for patient and family engagement are also a great tool for people to use that we will continue to update as well. Donna, people are also asking whether how can they distribute these materials to their own, through their own networks? How do we do that? Yeah, so anything that is linked on our website, people are free to go and link to or download our documents and use them in their own organization. So, Martha had asked a question about having a support group regarding COVID-19 for family caregivers somewhere near the hospital. Does anybody wanna talk about that? I think the real question would be, Martha, is how many people we could really have in any one place at a given time if we are practicing physical distancing? I think it's a fabulous idea and I think it's a great suggestion for hospitals, but it would likely need to be a virtual support group, I would think. And then we have another question from Steve Barker about elective surgeries and because the family needs to be able to discuss this in detail with physicians. And so, what would a patient or family member consider to be elective as opposed to what clinicians think is elective? Any thoughts from anybody? So I imagine most folks would be in direction from their clinicians. Oh my goodness, somebody's dog is... Don, what I would say about that is I would encourage the patients and families, the family members who are here and the family advocates here to really not be shy about really pressing just what Jan did, just sort of be that proactive person and saying, look at this, we know COVID-19 is going on, but there is, we need care for other things now too and be persistent about that. There's a series of commercials in Chicago right now about cancer care, not stopping because of C19 because it's so important and I'm glad to see those commercials because it helps us, the healthcare system still has to run for other patients as well. Okay, any final questions from the audience? Okay, well, I would like to thank all of our panelists here today. Thank you all very much for your participation. We've had an amazing brainstorming session with some great tips for hospitals and clinicians and patients and families. As I mentioned, we will be putting all of these resources on our website for everybody to access. They should be up there within a few hours. So thank you all very much panelists. I really appreciate your time. Thank you. I was like, are you like, I literally like just like froze for C19. All right, we will go ahead and the webinar now and we will have this recording also on our website very shortly. Thank you all very much. It's a wonderful day.